Provider Demographics
NPI:1376966960
Name:GALVAN, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
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:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-0642
Mailing Address - Country:US
Mailing Address - Phone:408-316-5221
Mailing Address - Fax:
Practice Address - Street 1:2925 NIAGRA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1056
Practice Address - Country:US
Practice Address - Phone:209-669-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376966960Medicaid