Provider Demographics
NPI:1225545080
Name:GALAVIZ, ESMERALDA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:GALAVIZ
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:ESMERALDA
Other - Middle Name:
Other - Last Name:GALAVIZ AGUAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:2444 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2306
Mailing Address - Country:US
Mailing Address - Phone:323-201-4130
Mailing Address - Fax:
Practice Address - Street 1:2444 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-201-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86058444133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered