Provider Demographics
NPI:1700297249
Name:RAZ, GALYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GALYA
Middle Name:
Last Name:RAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15708 POMERADO RD # N104
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2066
Mailing Address - Country:US
Mailing Address - Phone:858-485-1180
Mailing Address - Fax:858-485-1426
Practice Address - Street 1:15708 POMERADO RD # N104
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-485-1180
Practice Address - Fax:858-485-1426
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4-1061223P0300X
CA63404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics