Healthcare Provider Details

I. General information

NPI: 1215904206
Provider Name (Legal Business Name): REYNALDO AFABLE GALANG IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 TERRIER AVE BRANCH HEALTH CLINIC DAM NECK STE 100
VIRGINIA BEACH VA
23461-2298
US

IV. Provider business mailing address

1056 HAWTHORNE FARM TER
VIRGINIA BEACH VA
23454-6586
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7215
  • Fax: 757-314-7206
Mailing address:
  • Phone: 757-689-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: