Provider Demographics
NPI:1720198674
Name:GALLEGO, IAIN SCOTT (FNP)
Entity Type:Individual
Prefix:
First Name:IAIN
Middle Name:SCOTT
Last Name:GALLEGO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2016
Mailing Address - Country:US
Mailing Address - Phone:661-716-9400
Mailing Address - Fax:
Practice Address - Street 1:2701 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2016
Practice Address - Country:US
Practice Address - Phone:661-716-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481865363A00000X
CA11333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00072073OtherMEDICARE RAILROAD
CANP11333Medicaid
CAZZZ06298ZOtherMEDICARE PTAN
CAZZZ01707ZOtherMEDICARE GROUP PTAN
CAGR0092950OtherMEDI-CAL GROUP NUMBER
CAZZZ06298ZOtherMEDICARE PTAN