Healthcare Provider Details

I. General information

NPI: 1386349165
Provider Name (Legal Business Name): ABRAHAM GALVAN APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11636 PARK ST
BALLICO CA
95303-9701
US

IV. Provider business mailing address

11636 PARK ST
BALLICO CA
95303-9701
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-0156
  • Fax:
Mailing address:
  • Phone: 858-336-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC17103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: