Provider Demographics
NPI:1073177200
Name:GARCIA GALVAN, MARISSA (RN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GARCIA GALVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SIGNATURE POINT DR APT 612
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6511
Mailing Address - Country:US
Mailing Address - Phone:832-816-9000
Mailing Address - Fax:
Practice Address - Street 1:1 SIGNATURE POINT DR APT 612
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6511
Practice Address - Country:US
Practice Address - Phone:832-816-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744712163W00000X
TX744711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse