Provider Demographics
NPI:1457942294
Name:GALVAN, YESENIA HORTENCIA
Entity Type:Individual
Prefix:MRS
First Name:YESENIA
Middle Name:HORTENCIA
Last Name:GALVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YESENIA
Other - Middle Name:HORTENCIA
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 W VASSAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7096 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0462
Practice Address - Country:US
Practice Address - Phone:559-436-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90828183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician