MEDICARE: DR. VANJA ARLENE GALE PSY.D.

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
1	103T00000X	Psychologist	PSY19622	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OPL196220	OTHER	CA	BLUE SHIELD/TRICARE

General Provider Information

NPI Number	:	1699855528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANJA ARLENE GALE PSY.D.

Provider Business Mailing Address
First Line	:	3505 CAMINO DEL RIO S STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4016
Country	:	US
Telephone Number	:	619-281-0507
Fax Number	:	619-281-0907

Provider Business Practice Location Address
First Line	:	3505 CAMINO DEL RIO S STE 212
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4016
Country	:	US
Telephone Number	:	619-281-0507
Fax Number	:	619-281-0907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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