Healthcare Provider Details

I. General information

NPI: 1821976721
Provider Name (Legal Business Name): MAYRA ALEJANDRA GALICIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH AVE
UPLAND CA
91786-4839
US

IV. Provider business mailing address

601 5TH AVE
UPLAND CA
91786-4839
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-6526
  • Fax: 909-949-6526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: