Provider Demographics
NPI:1497143812
Name:GLENOAKS MEDICAL CARE
Entity Type:Organization
Organization Name:GLENOAKS MEDICAL CARE
Other - Org Name:GLENOAKS MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLANIGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:818-767-8811
Mailing Address - Street 1:8730 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2801
Mailing Address - Country:US
Mailing Address - Phone:818-767-8811
Mailing Address - Fax:
Practice Address - Street 1:8730 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2801
Practice Address - Country:US
Practice Address - Phone:818-767-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47749207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47749OtherMEDICAL LICENSE