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General NPI Number Information
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NPI Number | 1700297249
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Entity Type | Individual
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Provider Name | GALYA RAZ D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 15708 POMERADO RD # N104
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-485-1180
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Fax | 858-485-1426
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Provider Business Mailing Address
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Address Line | 15708 POMERADO RD # N104
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City | POWAY
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State | CA
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Zip | 92064-2066
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Country | US
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Telephone | 858-485-1180
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Fax | 858-485-1426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | S4-106
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63404
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License Number State | CA
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