Basic Information
| Provider Information | |||||||||
| NPI: | 1245577279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANAL | ||||||||
| FirstName: | MENALIN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8220 WYMARK DR | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957576297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166670600 | ||||||||
| FaxNumber: | 9166830232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116025434 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 20A13851 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.