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Organization
GLENDALE REJUVENATION MEDICAL GROUP
Active
Organization
GLENDALE REJUVENATION MEDICAL GROUP
Active
Other names
Glendale Rejuvenation Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDDIE SANTIAGO MANAGER (MANAGER)
(818) 610-9360
Entity
Organization
Contact information
Practice address
1703 N AVALON BLVD, WILMINGTON, CA 90744-1432
(310) 233-9355
(310) 233-2545
Mailing address
1703 N AVALON BLVD, WILMINGTON, CA 90744-1432
(818) 518-5980
(818) 551-0466
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
111NN1001X
Nutrition Chiropractor
—
—
133V00000X
Registered Dietitian
—
—
207K00000X
Allergy & Immunology Physician
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/16/2016
Last updated
12/21/2021
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