Provider Demographics
NPI:1811978323
Name:GALGUERA, MANUEL ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALFREDO
Last Name:GALGUERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3115
Mailing Address - Country:US
Mailing Address - Phone:305-805-0012
Mailing Address - Fax:305-883-9003
Practice Address - Street 1:1816 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3115
Practice Address - Country:US
Practice Address - Phone:305-805-0012
Practice Address - Fax:305-883-9003
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254645100Medicaid
FL43782Medicare ID - Type Unspecified