Provider Demographics
NPI:1225168024
Name:LUIS A. GALDAMEZ, MD INC.
Entity Type:Organization
Organization Name:LUIS A. GALDAMEZ, MD INC.
Other - Org Name:CLINICA MEDICA VIRGEN DE GUADALUPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-585-0732
Mailing Address - Street 1:2955 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5836
Mailing Address - Country:US
Mailing Address - Phone:323-585-0732
Mailing Address - Fax:323-585-1673
Practice Address - Street 1:2955 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5836
Practice Address - Country:US
Practice Address - Phone:323-585-0732
Practice Address - Fax:323-585-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050144208000000X
CAA048644208D00000X
CAPA17148363A00000X
CAPA12501363A00000X
CAPA15773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067940Medicaid
CAW14585Medicare ID - Type UnspecifiedGROUP NUMBER