Healthcare Provider Details

I. General information

NPI: 1669570610
Provider Name (Legal Business Name): JOHN GILBERT GALAZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 LUNA ST SE
LOS LUNAS NM
87031-9277
US

IV. Provider business mailing address

335 LUNA ST SE
LOS LUNAS NM
87031-9277
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4155
  • Fax:
Mailing address:
  • Phone: 505-865-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberLMT#974
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: