Healthcare Provider Details

I. General information

NPI: 1295160497
Provider Name (Legal Business Name): XAVIER O GALARZA LND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 14 KM 72.2 SECTOR LOMAS, BARRIO RINCON, HOSPITAL MENONITA CAYEY
CAYEY PR
00736
US

IV. Provider business mailing address

URB. BONNEVILLE VALLEY CALLE REY GASPAR #81
CAGUAS PUERTO RICO
00727
UM

V. Phone/Fax

Practice location:
  • Phone: 787-203-7870
  • Fax: 787-263-1602
Mailing address:
  • Phone: 787-203-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1640
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: