Provider Demographics
NPI:1073733283
Name:GALVAN, EVELYN CRUZ
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:CRUZ
Last Name:GALVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GREAT AMERICA PARKWAY STE. 124
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1231
Mailing Address - Country:US
Mailing Address - Phone:408-496-1016
Mailing Address - Fax:408-213-0789
Practice Address - Street 1:4300 GREAT AMERICA PKWY STE 124
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1231
Practice Address - Country:US
Practice Address - Phone:408-496-1016
Practice Address - Fax:408-213-0789
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist