Basic Information
Provider Information
NPI: 1972586097
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALANG
FirstName: M JACQUELINE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 334 NORTHGATE DR
Address2:  
City: MANTECA
State: CA
PostalCode: 953363139
CountryCode: US
TelephoneNumber: 2096428079
FaxNumber: 2092393408
Practice Location
Address1: 1262 E NORTH ST
Address2:  
City: MANTECA
State: CA
PostalCode: 95336
CountryCode: US
TelephoneNumber: 2092390120
FaxNumber: 2092390102
Other Information
ProviderEnumerationDate: 11/22/2005
LastUpdateDate: 08/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA69426CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
A69426005CA MEDICAID


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