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NPI Code Detail

MEDICARE: GALEY BETZLER MA

MEDICARE: GALEY BETZLER MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility057001447CA

General Provider Information

NPI Number : 1518424613
Entity Type Code : Individual
Provider Name (Legal Business Name) : GALEY BETZLER MA
Provider Business Mailing Address
First Line : 15011 LAGO DR
Second Line :
City : RANCHO MURIETA
State : CA
Zip : 95683-9513
Country : US
Telephone Number : 209-559-2655
Fax Number :
Provider Business Practice Location Address
First Line : 10400 FRICOT CITY ROAD
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-9642
Country : US
Telephone Number : 209-559-2655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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