Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013676808 |
---|---|
Provider Name | Miss Ruth A Galvan |
First Address | Larkspur, CA 94939-1825 |
Second Address | Greenbrae, CA 94904-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 04/01/2022 |