Provider Demographics
NPI:1467948679
Name:GALVAN, JESSICA MARI (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARI
Last Name:GALVAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25612 BARTON RD # 286
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:800-474-4848
Mailing Address - Fax:
Practice Address - Street 1:1971 ESSEX CT STE 1
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8061
Practice Address - Country:US
Practice Address - Phone:800-474-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189350164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse