Provider Demographics
NPI:1205207594
Name:GLAVIANO, VINCENT ANGELO (NP)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ANGELO
Last Name:GLAVIANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:424-315-2395
Mailing Address - Fax:424-315-2396
Practice Address - Street 1:12746 W JEFFERSON BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90094-2885
Practice Address - Country:US
Practice Address - Phone:424-315-2395
Practice Address - Fax:424-315-2396
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2295490363LF0000X
CA95017783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily