Healthcare Provider Details

I. General information

NPI: 1992453989
Provider Name (Legal Business Name): JESSICA KRISTINA GALARZA CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FRANCISCO ROSA, BARRIO CAPAEZ
HATILLO PR
00659
US

IV. Provider business mailing address

HC 4 BOX 41005
HATILLO PR
00659-8325
US

V. Phone/Fax

Practice location:
  • Phone: 787-242-2569
  • Fax:
Mailing address:
  • Phone: 787-242-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM22010008
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: