Provider Demographics
NPI:1235197500
Name:ENDENO-GALIMA, ELIZABETH MORENO (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MORENO
Last Name:ENDENO-GALIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-734-1247
Practice Address - Street 1:501 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5014
Practice Address - Country:US
Practice Address - Phone:559-734-1939
Practice Address - Fax:559-734-4384
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH53368Medicare UPIN