Provider Demographics
NPI:1770516379
Name:GALVEZ, MAURINA B (MD)
Entity type:Individual
Prefix:DR
First Name:MAURINA
Middle Name:B
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAURINA
Other - Middle Name:GALVAZ
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 715
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-878-3825
Mailing Address - Fax:773-878-9136
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 715
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-878-3825
Practice Address - Fax:773-878-9136
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36046910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics