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NPI Code Detail

MEDICARE: MRS. LYDONA F GALLIMBA GONZALEZ FNP

MEDICARE: MRS. LYDONA F GALLIMBA GONZALEZ FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95006013CA

General Provider Information

NPI Number : 1376101105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYDONA F GALLIMBA GONZALEZ FNP
Provider Business Mailing Address
First Line : 701 E 28TH ST STE 419
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2775
Country : US
Telephone Number : 562-490-9900
Fax Number :
Provider Business Practice Location Address
First Line : 701 E 28TH ST STE 419
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2775
Country : US
Telephone Number : 562-490-9900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2019
Last Update Date : 11/15/2022

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