Healthcare Provider Details

I. General information

NPI: 1811832520
Provider Name (Legal Business Name): ERICA DE GALICIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 DALE ST STE O
BUENA PARK CA
90621-4158
US

IV. Provider business mailing address

6061 DALE ST STE O
BUENA PARK CA
90621-4158
US

V. Phone/Fax

Practice location:
  • Phone: 714-381-1777
  • Fax: 714-707-3031
Mailing address:
  • Phone: 714-381-1777
  • Fax: 714-707-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: