Provider Demographics
NPI:1083855381
Name:GALICINAO, ERWIN C (RPT)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:C
Last Name:GALICINAO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12572 VALLEY VIEW
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2006
Mailing Address - Country:US
Mailing Address - Phone:714-823-4400
Mailing Address - Fax:714-823-4404
Practice Address - Street 1:5510 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:80712-1905
Practice Address - Country:US
Practice Address - Phone:562-677-3700
Practice Address - Fax:562-677-3705
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist