Provider Demographics
NPI:1437277092
Name:ABALOS-GALITO, MARIETTA FLORENCE (MD)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:FLORENCE
Last Name:ABALOS-GALITO
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 1:125 N JACKSON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-258-7827
Mailing Address - Fax:408-258-7829
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-258-7827
Practice Address - Fax:408-258-7829
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78499207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH72671Medicare UPIN
CADJ683AMedicare PIN