Provider Demographics
NPI:1114499050
Name:GALVAN, JOEL ANGEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ANGEL
Last Name:GALVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 E PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1243
Mailing Address - Country:US
Mailing Address - Phone:714-768-9692
Mailing Address - Fax:
Practice Address - Street 1:5832 BEACH BLVD UNIT 214
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-523-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty