Provider Demographics
NPI:1003338815
Name:GALVAN, DIANA BERENICE (MSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:BERENICE
Last Name:GALVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 CONCOURS APT 22E
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4887
Mailing Address - Country:US
Mailing Address - Phone:909-270-0106
Mailing Address - Fax:
Practice Address - Street 1:3350 CONCOURS ST
Practice Address - Street 2:APT 22E
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-270-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker