Provider Demographics
NPI:1851868053
Name:GALVEZ-HERNANDEZ, DIANALY (MA)
Entity Type:Individual
Prefix:
First Name:DIANALY
Middle Name:
Last Name:GALVEZ-HERNANDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DIANALY
Other - Middle Name:
Other - Last Name:GALVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5285 MEADOWS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3478
Mailing Address - Country:US
Mailing Address - Phone:503-726-5216
Mailing Address - Fax:
Practice Address - Street 1:5285 MEADOWS RD STE 170
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3478
Practice Address - Country:US
Practice Address - Phone:503-726-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7737106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765Medicaid