Healthcare Provider Details

I. General information

NPI: 1750014239
Provider Name (Legal Business Name): MONIQUE GALVEZ PT, DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE ILAGAN PT, DPT, GCS

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16203 CASTELLO LN
FONTANA CA
92336-6320
US

IV. Provider business mailing address

16203 CASTELLO LN
FONTANA CA
92336-6320
US

V. Phone/Fax

Practice location:
  • Phone: 718-801-3264
  • Fax:
Mailing address:
  • Phone: 718-801-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: