Provider Demographics
NPI:1093083651
Name:MARIETTA ABALOS-GALITO, MD INC
Entity Type:Organization
Organization Name:MARIETTA ABALOS-GALITO, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABALOS-GALITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-7827
Mailing Address - Street 1:125 N JACKSON AVE
Mailing Address - Street 2:SUITE NUMBER 107
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-258-7827
Mailing Address - Fax:408-258-7829
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:SUITE NUMBER 107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-258-7827
Practice Address - Fax:408-258-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78499207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADJ683BMedicare PIN
CAH72671Medicare UPIN