Provider Demographics
NPI:1982890018
Name:ABALOS-GALITO MEDICAL SERVICE
Entity Type:Organization
Organization Name:ABALOS-GALITO MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:ABALOS-GALITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-416-7551
Mailing Address - Street 1:3111 ANDORA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1202
Mailing Address - Country:US
Mailing Address - Phone:408-416-7551
Mailing Address - Fax:408-238-9347
Practice Address - Street 1:2593 S KING RD STE 11
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-274-2880
Practice Address - Fax:408-274-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A78499Medicaid
CA00A78499Medicaid