Healthcare Provider Details

I. General information

NPI: 1811978323
Provider Name (Legal Business Name): MANUEL ALFREDO GALGUERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 E 4TH AVE
HIALEAH FL
33010-3115
US

IV. Provider business mailing address

1816 E 4TH AVE
HIALEAH FL
33010-3115
US

V. Phone/Fax

Practice location:
  • Phone: 305-805-0012
  • Fax: 305-883-9003
Mailing address:
  • Phone: 305-805-0012
  • Fax: 305-883-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0075703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: