MEDICARE: JESSICA GALVEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SPA 2611	CA

General Provider Information

NPI Number	:	1871918185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GALVEZ

Provider Business Mailing Address
First Line	:	1570 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8502
Country	:	US
Telephone Number	:	714-834-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6076 BRISTOL PKWY STE 105
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6600
Country	:	US
Telephone Number	:	310-642-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	02/24/2014

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Directions to “ JESSICA GALVEZ ” Practice Location

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