Provider Demographics
NPI:1245757640
Name:GALVAN, JONNIE BELINDA
Entity Type:Individual
Prefix:
First Name:JONNIE
Middle Name:BELINDA
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 1:1908 BUSINESS CENTER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3468
Mailing Address - Country:US
Mailing Address - Phone:909-890-5930
Mailing Address - Fax:
Practice Address - Street 1:1908 BUSINESS CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3468
Practice Address - Country:US
Practice Address - Phone:909-890-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17624225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health