Provider Demographics
NPI:1467702043
Name:GALANG, NATHANIEL FAJARDO JR (NP-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:FAJARDO
Last Name:GALANG
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SAINT DOMINICS DR
Mailing Address - Street 2:STE 201
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7802
Mailing Address - Country:US
Mailing Address - Phone:209-239-0120
Mailing Address - Fax:209-239-0102
Practice Address - Street 1:165 SAINT DOMINICS DR
Practice Address - Street 2:STE 201
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7802
Practice Address - Country:US
Practice Address - Phone:209-239-0120
Practice Address - Fax:209-239-0102
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily