Provider Demographics
NPI:1659613792
Name:E.C.GALVAN DMD INC
Entity Type:Organization
Organization Name:E.C.GALVAN DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-453-0024
Mailing Address - Street 1:1674 N SHORELINE BLVD
Mailing Address - Street 2:STE. 126
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1374
Mailing Address - Country:US
Mailing Address - Phone:650-968-6141
Mailing Address - Fax:650-968-6299
Practice Address - Street 1:1674 N SHORELINE BLVD
Practice Address - Street 2:STE. 126
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1374
Practice Address - Country:US
Practice Address - Phone:650-968-6141
Practice Address - Fax:650-968-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39406302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization