1184712556 NPI number — DR. ALICIA GREGORIA GALVAN DDS, FAAHD

Table of content: DR. ALICIA GREGORIA GALVAN DDS, FAAHD (NPI 1184712556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184712556 NPI number — DR. ALICIA GREGORIA GALVAN DDS, FAAHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVAN
Provider First Name:
ALICIA
Provider Middle Name:
GREGORIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, FAAHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALVAN
Provider Other First Name:
ALICIA
Provider Other Middle Name:
GREGORIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184712556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7434 LOUIS PASTEUR DR
Provider Second Line Business Mailing Address:
STE. 234
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-4538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-617-4446
Provider Business Mailing Address Fax Number:
210-617-5572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7434 LOUIS PASTEUR DR
Provider Second Line Business Practice Location Address:
STE. 234
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-617-4446
Provider Business Practice Location Address Fax Number:
210-617-5572
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  21243 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)