Healthcare Provider Details

I. General information

NPI: 1174143457
Provider Name (Legal Business Name): ANGELA GALAVIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12417 PHILADELPHIA ST
WHITTIER CA
90601-3933
US

IV. Provider business mailing address

11710 NORINO DR
WHITTIER CA
90601-2203
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: