Provider Demographics
NPI:1407143274
Name:-GALBRAITH, MARCIA (PA)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:-GALBRAITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 SCHOONER DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-4520
Mailing Address - Country:US
Mailing Address - Phone:209-401-8717
Mailing Address - Fax:
Practice Address - Street 1:3449 SCHOONER DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-4520
Practice Address - Country:US
Practice Address - Phone:209-401-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant