Provider Demographics
NPI:1699855528
Name:GALE, VANJA ARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VANJA
Middle Name:ARLENE
Last Name:GALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CAMINO DEL RIO S STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4016
Mailing Address - Country:US
Mailing Address - Phone:619-281-0507
Mailing Address - Fax:619-281-0907
Practice Address - Street 1:3505 CAMINO DEL RIO S STE 212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4016
Practice Address - Country:US
Practice Address - Phone:619-281-0507
Practice Address - Fax:619-281-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY196220Medicaid
CAOPL196220OtherBLUE SHIELD/TRICARE