Provider Demographics
NPI:1457011256
Name:GLENDALE REJUVENATION MEDICAL GROUP
Entity Type:Organization
Organization Name:GLENDALE REJUVENATION MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-430-6312
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 405
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1940
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:
Practice Address - Street 1:1703 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1432
Practice Address - Country:US
Practice Address - Phone:818-518-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site