Healthcare Provider Details

I. General information

NPI: 1235197500
Provider Name (Legal Business Name): ELIZABETH MORENO ENDENO-GALIMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRIDGE ST
VISALIA CA
93291-5014
US

IV. Provider business mailing address

314 N MAIN ST
PORTERVILLE CA
93257-3730
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-1939
  • Fax: 559-734-4384
Mailing address:
  • Phone: 559-791-7000
  • Fax: 559-734-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: