Healthcare Provider Details

I. General information

NPI: 1114830635
Provider Name (Legal Business Name): TONY GALVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14413 ELMBROOK DR
LA MIRADA CA
90638-3815
US

IV. Provider business mailing address

14413 ELMBROOK DR
LA MIRADA CA
90638-3815
US

V. Phone/Fax

Practice location:
  • Phone: 562-505-6478
  • Fax:
Mailing address:
  • Phone: 562-505-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: