Provider Demographics
NPI:1326254020
Name:MEAD, GALENE Y (PA)
Entity Type:Individual
Prefix:MRS
First Name:GALENE
Middle Name:Y
Last Name:MEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5827 PINE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6534
Mailing Address - Country:US
Mailing Address - Phone:909-613-0016
Mailing Address - Fax:909-613-0026
Practice Address - Street 1:5827 PINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6534
Practice Address - Country:US
Practice Address - Phone:909-613-0016
Practice Address - Fax:909-613-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18739OtherPHYSICIAN ASSISTANT