Provider Demographics
NPI:1285638205
Name:GARCIA-GALAN, LYNN J (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:J
Last Name:GARCIA-GALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:J
Other - Last Name:GALAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2486 N PONDEROSA DR
Mailing Address - Street 2:STE D211
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-484-2818
Mailing Address - Fax:805-482-0028
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:STE D211
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-2818
Practice Address - Fax:805-482-0028
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-11-26
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CAG081766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75674ZMedicaid