Provider Demographics
NPI:1417526112
Name:GLENNDOC, INC
Entity Type:Organization
Organization Name:GLENNDOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-337-9351
Mailing Address - Street 1:31341 NIGUEL RD STE F&G
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&G
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty