Provider Demographics
NPI:1750566410
Name:GALVEZ TRISTAN, AMALIA ESMERALDA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMALIA
Middle Name:ESMERALDA
Last Name:GALVEZ TRISTAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMALIA
Other - Middle Name:ESMERALDA
Other - Last Name:GALVEZ TRISTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 6138
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91747-6138
Mailing Address - Country:US
Mailing Address - Phone:626-488-4486
Mailing Address - Fax:
Practice Address - Street 1:420 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3001
Practice Address - Country:US
Practice Address - Phone:626-919-5724
Practice Address - Fax:626-919-8503
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant