Provider Demographics
NPI:1417009671
Name:GALVEZ, CONNIE J (NP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:J
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-349-8972
Mailing Address - Fax:805-349-8958
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-349-8972
Practice Address - Fax:805-349-8958
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA186786363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA186786OtherSTATE LICENSE NUMBER
CA186786OtherSTATE LICENSE NUMBER