Provider Demographics
NPI:1467917161
Name:GALOFRE, LINA ISABEL II (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:ISABEL
Last Name:GALOFRE
Suffix:II
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 1:27 WILLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2253
Mailing Address - Country:US
Mailing Address - Phone:619-414-7141
Mailing Address - Fax:
Practice Address - Street 1:27 WILLOW TREE LN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2253
Practice Address - Country:US
Practice Address - Phone:619-414-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1035201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG416529589280OtherDRIVER LICENSE