Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 04-34565 | KS |
Y | 207KA0200X | Allergist | M1688 | TX |
NPI | 1235316308 |
---|---|
Provider Name | Dalia Giovanna Galicia |
First Address | Fort Worth, TX 76244-6306 |
Second Address | Fort Worth, TX 76244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 19/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200673110A | (05) | KS |