MEDICARE: MRS. NOELIA REBECA GALVEZ-NELSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW71174	CA

General Provider Information

NPI Number	:	1487840369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NOELIA REBECA GALVEZ-NELSON LCSW

Provider Business Mailing Address
First Line	:	27261 LAS RAMBLAS
Second Line	:	SUITE 100
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34324 YUCAIPA BLVD
Second Line	:	SUITE B-D
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2496
Country	:	US
Telephone Number	:	909-790-1300
Fax Number	:	909-797-9687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	06/08/2016

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