Provider Demographics
NPI:1669570610
Name:GALAZ, JOHN GILBERT (LMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:GALAZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 LUNA ST SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9277
Mailing Address - Country:US
Mailing Address - Phone:505-865-4155
Mailing Address - Fax:
Practice Address - Street 1:335 LUNA ST SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9277
Practice Address - Country:US
Practice Address - Phone:505-865-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT#974175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath