Provider Demographics
NPI:1942728217
Name:GLOVER, JANELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-2640
Mailing Address - Fax:310-967-0669
Practice Address - Street 1:8631 W 3RD ST STE 240E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5970
Practice Address - Country:US
Practice Address - Phone:310-423-2640
Practice Address - Fax:310-967-0669
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06697363A00000X
CAPA59693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC06697OtherLICENSE