Provider Demographics
NPI:1215194865
Name:GALVIZO, DAVE JIMENES (IDHS)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:JIMENES
Last Name:GALVIZO
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRUMBO PT RD
Mailing Address - Street 2:USCGC MOHAWK WMEC 913
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040
Mailing Address - Country:US
Mailing Address - Phone:305-292-8750
Mailing Address - Fax:305-292-8792
Practice Address - Street 1:100 TRUMBO PT RD
Practice Address - Street 2:USCGC MOHAWK WMEC 913
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-292-8750
Practice Address - Fax:305-292-8792
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other