Provider Demographics
NPI:1114280443
Name:GLENN, BRITTANY C (DO)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:C
Last Name:GLENN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31341 NIGUEL RD STE F
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4118
Mailing Address - Country:US
Mailing Address - Phone:949-444-5803
Mailing Address - Fax:949-444-5804
Practice Address - Street 1:31341 NIGUEL RD STE F
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4118
Practice Address - Country:US
Practice Address - Phone:949-444-5803
Practice Address - Fax:949-444-5804
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15745207P00000X
PAOT014759390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program