Healthcare Provider Details

I. General information

NPI: 1245064807
Provider Name (Legal Business Name): MARTINA GALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PINKSTON LN
POCOLA OK
74902-3464
US

IV. Provider business mailing address

901 PINKSTON LN
POCOLA OK
74902-3464
US

V. Phone/Fax

Practice location:
  • Phone: 918-884-6835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: