Provider Demographics
NPI:1790719482
Name:D'ARPA, GLENN D (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:D'ARPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10225 AUSTIN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1521
Mailing Address - Country:US
Mailing Address - Phone:616-660-6003
Mailing Address - Fax:619-660-0296
Practice Address - Street 1:10225 AUSTIN DR STE 101
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1521
Practice Address - Country:US
Practice Address - Phone:616-660-6003
Practice Address - Fax:619-660-0296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD77222Medicare UPIN