Healthcare Provider Details

I. General information

NPI: 1629735097
Provider Name (Legal Business Name): WILVER ISRAEL GONZALEZ-GALDAMEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR STE 112
LA QUINTA CA
92253-7243
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 760-771-9054
  • Fax: 760-771-9057
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: