Provider Demographics
NPI:1841064151
Name:GARCIA GALVAN, NATHALY MARLENNE
Entity type:Individual
Prefix:
First Name:NATHALY
Middle Name:MARLENNE
Last Name:GARCIA 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 1:4508 SUGAR CANE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2947
Mailing Address - Country:US
Mailing Address - Phone:661-380-8259
Mailing Address - Fax:
Practice Address - Street 1:1625 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4931
Practice Address - Country:US
Practice Address - Phone:661-389-1744
Practice Address - Fax:661-398-8017
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice