Provider Demographics
NPI:1952724247
Name:GALVEZ, GINA ALEXANDRA (MS, PA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ALEXANDRA
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5605
Mailing Address - Country:US
Mailing Address - Phone:718-208-5575
Mailing Address - Fax:
Practice Address - Street 1:1234 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1613
Practice Address - Country:US
Practice Address - Phone:310-451-8880
Practice Address - Fax:310-451-8803
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical