Provider Demographics
NPI:1043823305
Name:GALVEZ, GUILLERMO (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:GALVEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3724
Mailing Address - Country:US
Mailing Address - Phone:323-283-5765
Mailing Address - Fax:
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4192
Practice Address - Country:US
Practice Address - Phone:818-246-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily