Provider Demographics
NPI:1437987211
Name:GARALZA, MARIELLE HANNA VALDEZ
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:HANNA VALDEZ
Last Name:GARALZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6019
Mailing Address - Country:US
Mailing Address - Phone:818-489-7033
Mailing Address - Fax:
Practice Address - Street 1:18623 HAYNES ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6019
Practice Address - Country:US
Practice Address - Phone:818-489-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program