Provider Demographics
NPI:1891848453
Name:GALVAN DE BARBOSA, ADRIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:GALVAN DE BARBOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1609
Mailing Address - Country:US
Mailing Address - Phone:323-478-1515
Mailing Address - Fax:323-254-6622
Practice Address - Street 1:4901 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1609
Practice Address - Country:US
Practice Address - Phone:323-478-1515
Practice Address - Fax:323-254-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA457876OtherUNITED CONCORDIA
CAB40592OtherDENTICAL
CA5176OtherPACIFIC UNION DENTAL