Individual
GLORY CABANILLA TANCINCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6245 DE LONGPRE AVE, LOS ANGELES, CA 90028-8253
(234) 622-2713
Mailing address
PO BOX 60790, PASADENA, CA 91116-6790
(213) 413-0327
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C50519
CA
207LP3000X
Pediatric Anesthesiology Physician
C50519
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C505190
—
CA
Enumeration date
04/20/2007
Last updated
10/17/2019
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