Provider Demographics
NPI:1841766979
Name:GALVAN, REGINA A
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:A
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 1:2001 E LOHMAN AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3198
Mailing Address - Country:US
Mailing Address - Phone:575-232-9022
Mailing Address - Fax:575-288-2701
Practice Address - Street 1:2001 E LOHMAN AVE STE 112
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3198
Practice Address - Country:US
Practice Address - Phone:575-232-9022
Practice Address - Fax:575-288-2701
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHAD0916237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist