Provider Demographics
NPI:1154458958
Name:IRANI, GLENN RIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RIDA
Last Name:IRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-344-7600
Mailing Address - Fax:818-996-9709
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-344-7600
Practice Address - Fax:818-996-9709
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG059963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics