Provider Demographics
NPI:1881737302
Name:GALUTIRA, MACBETH LAMUG (LVN)
Entity type:Individual
Prefix:MRS
First Name:MACBETH
Middle Name:LAMUG
Last Name:GALUTIRA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9388 EXETER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2024
Mailing Address - Country:US
Mailing Address - Phone:951-205-6427
Mailing Address - Fax:909-625-3367
Practice Address - Street 1:9388 EXETER AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2024
Practice Address - Country:US
Practice Address - Phone:951-205-6427
Practice Address - Fax:909-625-3367
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 82000164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2401237Medicaid