Provider Demographics
NPI:1922274257
Name:GLORY CABANILLA TANCINCO,M.D. INC.
Entity Type:Organization
Organization Name:GLORY CABANILLA TANCINCO,M.D. INC.
Other - Org Name:GLORY CABANILLA TANCINCO,M.D.INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:CABANILLA
Authorized Official - Last Name:TANCINCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-2280
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-413-2280
Mailing Address - Fax:213-413-0327
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE #111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-413-2280
Practice Address - Fax:213-413-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC505190207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505190Medicaid
CA47864Medicare UPIN