Healthcare Provider Details

I. General information

NPI: 1174445969
Provider Name (Legal Business Name): MONIQUE LORRAINE GALAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 FOOTHILL BLVD #1059
LA VERNE CA
91750
US

IV. Provider business mailing address

450 W FOOTHILL BLVD APT 83
POMONA CA
91767-1057
US

V. Phone/Fax

Practice location:
  • Phone: 909-295-2265
  • Fax:
Mailing address:
  • Phone: 909-295-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-02327023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: