Healthcare Provider Details

I. General information

NPI: 1497289375
Provider Name (Legal Business Name): AITZA GALARZA-HERNANDEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 IRON GATE DR STE 101
WILMINGTON NC
28412-6624
US

IV. Provider business mailing address

7517 QUAIL WOODS RD
WILMINGTON NC
28411-7273
US

V. Phone/Fax

Practice location:
  • Phone: 910-202-9113
  • Fax: 910-202-9289
Mailing address:
  • Phone: 910-431-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4754
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: