Provider Demographics
NPI:1730166406
Name:WANIA-GALICIA, LANA LOUIE A (MD)
Entity type:Individual
Prefix:
First Name:LANA LOUIE
Middle Name:A
Last Name:WANIA-GALICIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LANA LOUIE
Other - Middle Name:A
Other - Last Name:WANIA-GALICIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:530 W LOS ANGELES AVE
Mailing Address - Street 2:STE 115, MS 343
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1746
Mailing Address - Country:US
Mailing Address - Phone:805-222-4549
Mailing Address - Fax:805-529-4549
Practice Address - Street 1:865 PATRIOT DR
Practice Address - Street 2:SUITE 201A
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3407
Practice Address - Country:US
Practice Address - Phone:805-222-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80078207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00036928OtherRAILROAD MEDICARE PIN
CAH87912Medicare UPIN
CAP00036928OtherRAILROAD MEDICARE PIN
CA00A800781Medicare PIN