Healthcare Provider Details

I. General information

NPI: 1700634490
Provider Name (Legal Business Name): TANYA GALINDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S IKE AVE
MONAHANS TX
79756-4737
US

IV. Provider business mailing address

1801 PETROLEUM DR
ODESSA TX
79762-4540
US

V. Phone/Fax

Practice location:
  • Phone: 432-943-6723
  • Fax:
Mailing address:
  • Phone: 432-258-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2155777
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: