Provider Demographics
NPI:1871555359
Name:GALVAN, OLIVIA AURORA (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:AURORA
Last Name:GALVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:387 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 103 PMB 338
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3307
Mailing Address - Country:US
Mailing Address - Phone:951-808-9909
Mailing Address - Fax:951-808-9939
Practice Address - Street 1:800 MAGNOLIA AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3123
Practice Address - Country:US
Practice Address - Phone:951-808-9909
Practice Address - Fax:951-808-9939
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE39092Medicare UPIN