Basic Information
| Provider Information | |||||||||
| NPI: | 1417009671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALVEZ | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 S PALISADE DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934548904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053498972 | ||||||||
| FaxNumber: | 8053498958 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 S PALISADE DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934548904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053498972 | ||||||||
| FaxNumber: | 8053498958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 186786 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 186786 | 01 | CA | STATE LICENSE NUMBER | OTHER |