Healthcare Provider Details

I. General information

NPI: 1093652679
Provider Name (Legal Business Name): DARWIN GUEVARRA GALICIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S MCDOWELL BLVD
PETALUMA CA
94954-5434
US

IV. Provider business mailing address

1004 S MCDOWELL BLVD
PETALUMA CA
94954-5434
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-8631
  • Fax:
Mailing address:
  • Phone: 415-209-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number496804020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: