Provider Demographics
NPI:1508092859
Name:GALAMAGA, MARY CHARLENE (LMT)
Entity Type:Individual
Prefix:
First Name:MARY CHARLENE
Middle Name:
Last Name:GALAMAGA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SW 10TH AVE
Mailing Address - Street 2:#K106
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1294
Mailing Address - Country:US
Mailing Address - Phone:561-265-3782
Mailing Address - Fax:
Practice Address - Street 1:1301 SW 10TH AVE
Practice Address - Street 2:#K106
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1294
Practice Address - Country:US
Practice Address - Phone:561-265-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0013264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist