Provider Demographics
NPI:1760057715
Name:GALVAN, ALONDRA JOHANA
Entity Type:Individual
Prefix:
First Name:ALONDRA
Middle Name:JOHANA
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 1:2375 RIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5243
Mailing Address - Country:US
Mailing Address - Phone:619-415-7703
Mailing Address - Fax:
Practice Address - Street 1:2375 RIDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5243
Practice Address - Country:US
Practice Address - Phone:619-415-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician