Provider Demographics
NPI:1891975579
Name:GATTIS, GALEN HAROLD (FNP-C)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:HAROLD
Last Name:GATTIS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BAYVIEW HEIGHTS DR
Mailing Address - Street 2:SPACE 135
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5526
Mailing Address - Country:US
Mailing Address - Phone:619-980-1650
Mailing Address - Fax:
Practice Address - Street 1:2003 BAYVIEW HEIGHTS DR
Practice Address - Street 2:SPACE 135
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5526
Practice Address - Country:US
Practice Address - Phone:619-980-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily