Healthcare Provider Details

I. General information

NPI: 1649260803
Provider Name (Legal Business Name): RICHARD GALICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 W DONINGTON ST
GLENDORA CA
91741-1844
US

IV. Provider business mailing address

PO BOX 428
GLENDORA CA
91740-0428
US

V. Phone/Fax

Practice location:
  • Phone: 626-644-0840
  • Fax:
Mailing address:
  • Phone: 626-644-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG18435
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG18435
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number16450
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD00009497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: