Provider Demographics
NPI:1720809254
Name:GALERA, EMMANUEL JARED (RN)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:JARED
Last Name:GALERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 WEBBER WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-4371
Mailing Address - Country:US
Mailing Address - Phone:425-622-6089
Mailing Address - Fax:
Practice Address - Street 1:1758 WEBBER WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-4371
Practice Address - Country:US
Practice Address - Phone:425-622-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95388272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse