Provider Demographics
NPI:1336761295
Name:GLENDALE WHOLE HEALTH
Entity Type:Organization
Organization Name:GLENDALE WHOLE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:310-923-3030
Mailing Address - Street 1:230 N MARYLAND AAVE #110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:818-551-0464
Mailing Address - Fax:818-551-0462
Practice Address - Street 1:230 N MARYLAND AAVE #110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:808-551-0464
Practice Address - Fax:818-551-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty