Provider Demographics
NPI:1952500241
Name:GALDAMEZ, IMELDA PILAR
Entity Type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:PILAR
Last Name:GALDAMEZ
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 1:4880 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2010
Mailing Address - Country:US
Mailing Address - Phone:313-846-6030
Mailing Address - Fax:313-846-2751
Practice Address - Street 1:4880 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2010
Practice Address - Country:US
Practice Address - Phone:313-846-6030
Practice Address - Fax:313-846-2751
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health