Provider Demographics
NPI:1295104511
Name:GALVAN, ERNESTO JR (CSA CFA)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:GALVAN
Suffix:JR
Gender:M
Credentials:CSA CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15039 GOLDENWEST ST STE 121
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2710
Mailing Address - Country:US
Mailing Address - Phone:714-501-7134
Mailing Address - Fax:714-794-6271
Practice Address - Street 1:15039 GOLDENWEST ST STE 121
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2710
Practice Address - Country:US
Practice Address - Phone:714-501-7134
Practice Address - Fax:714-794-6271
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00F997246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00F997OtherCERTIFIED SURGICAL ASSISTANT CERTIFIED FIRST ASSISTANT