Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1015713 | TX |
NPI | 1003416207 |
---|---|
Provider Name | Mrs. Adeline Galvez |
First Address | Fort Worth, TX 76104-2820 |
Second Address | Fort Worth, TX 76104-2820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 27/10/2020 |