Provider Demographics
NPI:1154495695
Name:GLENN J. HUBER, M.D., INC.
Entity Type:Organization
Organization Name:GLENN J. HUBER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-316-6190
Mailing Address - Street 1:23456 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4716
Mailing Address - Country:US
Mailing Address - Phone:310-316-6190
Mailing Address - Fax:310-540-7362
Practice Address - Street 1:23456 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:310-316-6190
Practice Address - Fax:310-540-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65106207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty