Provider Demographics
NPI:1184821464
Name:GALVIN, COLLEEN MARIE (PA NMD DACM PHD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE
Last Name:GALVIN
Suffix:
Gender:F
Credentials:PA NMD DACM PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HUGHES STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2060
Mailing Address - Country:US
Mailing Address - Phone:415-404-2567
Mailing Address - Fax:
Practice Address - Street 1:6 HUGHES STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2060
Practice Address - Country:US
Practice Address - Phone:415-404-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108062363AM0700X
CA12889363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical