Provider Demographics
NPI:1730759481
Name:GALVAN, ANTHONIE
Entity type:Individual
Prefix:
First Name:ANTHONIE
Middle Name:
Last Name:GALVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 AVENUE 152
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-9346
Mailing Address - Country:US
Mailing Address - Phone:559-572-4842
Mailing Address - Fax:
Practice Address - Street 1:160 N L ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4114
Practice Address - Country:US
Practice Address - Phone:559-572-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF3372916106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician