1649469750 NPI number — KATHLEEN GALLAHER, M.D.

Table of content: (NPI 1649469750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649469750 NPI number — KATHLEEN GALLAHER, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN GALLAHER, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649469750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17871 SANTIAGO BLVD STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLA PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92861-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-974-1362
Provider Business Mailing Address Fax Number:
714-974-3145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17871 SANTIAGO BLVD STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92861-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-974-1362
Provider Business Practice Location Address Fax Number:
714-974-3145
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAHER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
EMILIE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
714-974-1362

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A40219 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00004108 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com