Provider Demographics
NPI:1336483569
Name:SADANG, AURELIO EDWARD GALANG (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AURELIO EDWARD
Middle Name:GALANG
Last Name:SADANG
Suffix:
Gender:M
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:GALANG
Other - Last Name:SADANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, PMHNP, RN
Mailing Address - Street 1:1200 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3423
Mailing Address - Country:US
Mailing Address - Phone:415-690-0630
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1001
Practice Address - Country:US
Practice Address - Phone:510-483-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646146163W00000X
CA95000461363LF0000X, 363L00000X
CA2018003515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000461OtherBOARD OF REGISTERED NURSING
CA646146OtherBOARD OF REGISTERED NURSING