Basic Information
Provider Information
NPI: 1326545146
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALARZA
FirstName: STELLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 250 N COLLEGE PARK DR APT D22
Address2:  
City: UPLAND
State: CA
PostalCode: 917869459
CountryCode: US
TelephoneNumber: 6264371459
FaxNumber:  
Practice Location
Address1: 831 E ARROW HWY
Address2:  
City: POMONA
State: CA
PostalCode: 917672535
CountryCode: US
TelephoneNumber: 9093984383
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/09/2018
LastUpdateDate: 03/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X4690CAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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