Provider Demographics
NPI:1376880211
Name:GALAVIZ, MARTHA ALICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ALICIA
Last Name:GALAVIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3565
Mailing Address - Country:US
Mailing Address - Phone:562-942-2144
Mailing Address - Fax:562-942-0814
Practice Address - Street 1:6505 ROSEMEAD BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3565
Practice Address - Country:US
Practice Address - Phone:562-942-2144
Practice Address - Fax:562-942-0814
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist