Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 17624 | CA |
NPI | 1245757640 |
---|---|
Provider Name | Jonnie Belinda Galvan |
First Address | San Bernardino, CA 92408-3468 |
Second Address | San Bernardino, CA 92408-3468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |