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General NPI Number Information
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NPI Number | 1437685666
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Entity Type | Individual
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Provider Name | LISA GALVAN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 3316 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-1537
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Country | US
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Telephone | 323-722-4529
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 E. FOOTHILL, 2ND FL,
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City | PASADENA
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State | CA
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Zip | 91107
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Country | US
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Telephone | 626-744-5230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | R1260480817
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License Number State | CA
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