Provider Demographics
NPI:1528380615
Name:GMBT LLC
Entity Type:Organization
Organization Name:GMBT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:RALLECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-281-4445
Mailing Address - Street 1:368 W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4714
Mailing Address - Country:US
Mailing Address - Phone:951-281-4445
Mailing Address - Fax:951-371-5062
Practice Address - Street 1:21615 BERENDO AVE STE 400
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1800
Practice Address - Country:US
Practice Address - Phone:951-281-4445
Practice Address - Fax:951-371-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163WD1100X163WD1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty