Healthcare Provider Details

I. General information

NPI: 1013676808
Provider Name (Legal Business Name): MISS RUTH A GALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD UNIT B
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

9 DRAKES WAY
LARKSPUR CA
94939-1825
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6392
  • Fax:
Mailing address:
  • Phone: 415-419-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ACRHXU
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: