Provider Demographics
NPI:1861722035
Name:MEDINA GALVAN, DIANA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MEDINA GALVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13531 WILL CLAYTON PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4851
Mailing Address - Country:US
Mailing Address - Phone:832-391-5300
Mailing Address - Fax:
Practice Address - Street 1:101 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1705
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:415-231-5332
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine