Provider Demographics
NPI:1073893376
Name:GALVAN, DANIEL TIJERNA
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TIJERNA
Last Name:GALVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DANNY
Other - Middle Name:TIJERNA
Other - Last Name:GALVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QRP
Mailing Address - Street 1:2212 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1921
Mailing Address - Country:US
Mailing Address - Phone:806-379-7311
Mailing Address - Fax:806-372-3984
Practice Address - Street 1:3615 SW 45TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5662
Practice Address - Country:US
Practice Address - Phone:806-379-7311
Practice Address - Fax:806-372-3984
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009381247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other