Provider Demographics
NPI:1598216269
Name:MCGLYNN, KIRSTEN (CMT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13980 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5121
Mailing Address - Country:US
Mailing Address - Phone:408-445-8400
Mailing Address - Fax:
Practice Address - Street 1:13980 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5121
Practice Address - Country:US
Practice Address - Phone:408-445-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist