Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A109026 | CA |
NPI | 1033303524 |
---|---|
Provider Name | Dr. Justin M Galovich |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 20/12/2019 |