Basic Information
| Provider Information | |||||||||
| NPI: | 1083683080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALVEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16455 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852116455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806152010 | ||||||||
| FaxNumber: | 4808550706 | ||||||||
| Practice Location | |||||||||
| Address1: | 604 W WARNER RD | ||||||||
| Address2: | D2 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852252906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806152010 | ||||||||
| FaxNumber: | 4808550706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 32761 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 860735 | 01 | AZ | AHCCCS ID NUMBER | OTHER |