Healthcare Provider Details

I. General information

NPI: 1154802445
Provider Name (Legal Business Name): KARINA LYNN GALVIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 CALLE DE LAS FOCAS
SAN CLEMENTE CA
92672-4538
US

IV. Provider business mailing address

3818 CALLE DE LAS FOCAS
SAN CLEMENTE CA
92672-4538
US

V. Phone/Fax

Practice location:
  • Phone: 949-702-3279
  • Fax:
Mailing address:
  • Phone: 949-702-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: