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NPI Code Detail

MEDICARE: MS. MIRAH-AIZZA REYES GALUEGO PA

MEDICARE: MS. MIRAH-AIZZA REYES GALUEGO PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant60371CA
2390200000XStudent in an Organized Health Care Education/Training Program
3363AM0700XMedical Physician Assistant60371CA

General Provider Information

NPI Number : 1992326573
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MIRAH-AIZZA REYES GALUEGO PA
Provider Business Mailing Address
First Line : 737 W CHILDS AVE
Second Line :
City : MERCED
State : CA
Zip : 95341-6805
Country : US
Telephone Number : 866-682-4842
Fax Number :
Provider Business Practice Location Address
First Line : 2240 W MONTE VISTA AVE
Second Line :
City : TURLOCK
State : CA
Zip : 95382-9667
Country : US
Telephone Number : 866-682-4842
Fax Number : 209-667-1269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2020
Last Update Date : 01/13/2022

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