Healthcare Provider Details

I. General information

NPI: 1629161385
Provider Name (Legal Business Name): GALUST GARY HALAJYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE ROOM #F 2027
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

PO BOX 2757
ORANGE CA
92859-0757
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax:
Mailing address:
  • Phone: 714-973-2650
  • Fax: 714-973-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA69068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: