Healthcare Provider Details

I. General information

NPI: 1326905076
Provider Name (Legal Business Name): EVELYN GALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S COAST DR STE 260
COSTA MESA CA
92626-7719
US

IV. Provider business mailing address

23841 LARKWOOD LN
LAKE FOREST CA
92630-5137
US

V. Phone/Fax

Practice location:
  • Phone: 949-524-4313
  • Fax:
Mailing address:
  • Phone: 949-524-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: