Provider Demographics
NPI:1407332919
Name:ZALDIVAR GALVES, IDALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:IDALBERTO
Middle Name:
Last Name:ZALDIVAR GALVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3940
Mailing Address - Country:US
Mailing Address - Phone:626-813-2850
Mailing Address - Fax:
Practice Address - Street 1:2901 SILLECT AVE STE 201
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6373
Practice Address - Country:US
Practice Address - Phone:661-327-2101
Practice Address - Fax:661-327-2554
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA173456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program