Provider Demographics
NPI:1790738169
Name:GALLOWAY, JENNY R (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ELIZABETH
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:13112 EVENING CREEK DR S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4108
Practice Address - Country:US
Practice Address - Phone:858-668-4392
Practice Address - Fax:310-698-7054
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83749207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ37429OtherMEDICAL LICENSE
ORMD153421OtherMEDICAL LICENSE
CODR-49244OtherMEDICAL LICENSE
NV13235OtherMEDICAL LICENSE
NMMD2010-0236OtherMEDICAL LICENSE
NV13235OtherMEDICAL LICENSE