Provider Demographics
NPI:1598429862
Name:GALVAN, JENNIFER G
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
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 1:11971 ART ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2406
Mailing Address - Country:US
Mailing Address - Phone:323-517-7731
Mailing Address - Fax:
Practice Address - Street 1:8399 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-2354
Practice Address - Country:US
Practice Address - Phone:818-593-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator