Basic Information
| Provider Information | |||||||||
| NPI: | 1548428949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALANOS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 WEST BUNNY AVENUE | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934582805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052420614 | ||||||||
| FaxNumber: | 8054571550 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 CASA STREET | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052420614 | ||||||||
| FaxNumber: | 8054571550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 11/06/2015 | ||||||||
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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 | 363L00000X | 6628 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 364928 | 01 | CA | RN LICENSE # | OTHER | 6628 | 01 | CA | NP LICENSE # | OTHER | CB234327 | 01 | CA | MEDICARE ID | OTHER |