Provider Demographics
NPI:1851599427
Name:GALICIA, CHRISTIAN ROSARIO (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ROSARIO
Last Name:GALICIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1797
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286-1797
Mailing Address - Country:US
Mailing Address - Phone:818-949-4900
Mailing Address - Fax:818-949-7311
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-949-4900
Practice Address - Fax:818-949-7311
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant