Healthcare Provider Details

I. General information

NPI: 1891335881
Provider Name (Legal Business Name): LIDYA PAOLA GALVAN REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N PERIMETER RD
GREAT FALLS MT
59402-6701
US

IV. Provider business mailing address

4826 LORRAYNE PL
KLAMATH FALLS OR
97603-8354
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-3095
  • Fax:
Mailing address:
  • Phone: 650-452-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: