Individual
MR. GLENN PATRICK TAJALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
161 EXETER WAY, CORONA, CA 92882-8502
(714) 675-9089
Mailing address
161 EXETER WAY, CORONA, CA 92882-8502
(714) 675-9089
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
246Z00000X
Other Specialist/Technologist
Primary
—
CA
Other
Enumeration date
02/02/2023
Last updated
02/02/2023
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