Provider Demographics
NPI:1437613379
Name:GALARZA, D'ANDRA LYN
Entity Type:Individual
Prefix:
First Name:D'ANDRA
Middle Name:LYN
Last Name:GALARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 N LUGO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2253
Mailing Address - Country:US
Mailing Address - Phone:917-816-3040
Mailing Address - Fax:
Practice Address - Street 1:3465 N LUGO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2253
Practice Address - Country:US
Practice Address - Phone:917-816-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty