Provider Demographics
NPI:1679604417
Name:GALDAMEZ, LUIS A (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:GALDAMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9635 GARNISH DR
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3001
Mailing Address - Country:US
Mailing Address - Phone:562-904-9977
Mailing Address - Fax:
Practice Address - Street 1:2955 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5836
Practice Address - Country:US
Practice Address - Phone:323-585-0732
Practice Address - Fax:323-585-1673
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48644208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486440Medicaid
CAWA48644FMedicare ID - Type UnspecifiedRENDERING PROVIDER NUMBER
CA00A486440Medicaid