Provider Demographics
NPI:1750648184
Name:GALLAGHER, KINDAL ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KINDAL
Middle Name:ANNE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W PARR AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1442
Mailing Address - Country:US
Mailing Address - Phone:408-370-3100
Mailing Address - Fax:408-370-3790
Practice Address - Street 1:700 W PARR AVE
Practice Address - Street 2:SUITE I
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1442
Practice Address - Country:US
Practice Address - Phone:408-370-3100
Practice Address - Fax:408-370-3790
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical