Phillips, Glenn

Phillips, Glenn is an individual health care provider with primary practice located at 23512 Madero , Mission Viejo CA 92691-2743. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Phillips, Glenn can be contacted via phone (949) 583-1600.

Contact Information

Primary practice address
23512 Madero Mission Viejo CA 92691-2743
Phone: (949) 583-1600
Fax: (949) 454-8067
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA 10513 California

Profile Details

NPI number 1023090487
LBN Legal business name Phillips, Glenn
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
Last updated May 26th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023090487 NPPES
California MEDICAID PA10513

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