Provider Demographics
NPI:1497941363
Name:GLENDORA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GLENDORA MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PLARIDEL
Authorized Official - Middle Name:CERNA
Authorized Official - Last Name:ATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-335-0208
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-1433
Mailing Address - Country:US
Mailing Address - Phone:626-335-0208
Mailing Address - Fax:626-857-9418
Practice Address - Street 1:405 E. ALOSTA
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-335-0208
Practice Address - Fax:626-857-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25167208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A251670Medicaid
CAW13020Medicare PIN