Provider Demographics
NPI:1306970579
Name:GALVEZ, LORRAINE (RD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 1050 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-3309
Mailing Address - Country:US
Mailing Address - Phone:801-369-5212
Mailing Address - Fax:
Practice Address - Street 1:275 W 200 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5009
Practice Address - Country:US
Practice Address - Phone:801-796-1333
Practice Address - Fax:801-796-0625
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5119775-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered