Provider Demographics
NPI:1972586097
Name:GALANG, M JACQUELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:M JACQUELINE
Middle Name:
Last Name:GALANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3139
Mailing Address - Country:US
Mailing Address - Phone:209-642-8079
Mailing Address - Fax:209-239-3408
Practice Address - Street 1:1262 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336
Practice Address - Country:US
Practice Address - Phone:209-239-0120
Practice Address - Fax:209-239-0102
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA694260Medicaid