Healthcare Provider Details

I. General information

NPI: 1508711185
Provider Name (Legal Business Name): BEVERLY HERNANDO GLAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24630 WASHINGTON AVE STE 102
MURRIETA CA
92562-6177
US

IV. Provider business mailing address

170 S DOMMER AVE
WALNUT CA
91789-2314
US

V. Phone/Fax

Practice location:
  • Phone: 442-224-3320
  • Fax:
Mailing address:
  • Phone: 626-251-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: