Individual
MR. GLENN PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
23512 MADERO, MISSION VIEJO, CA 92691-2743
(949) 583-1600
(949) 454-8067
Mailing address
17360 BROOKHURST ST, ATTN: CREDENTIALING DEPARTMENT, FOUNTAIN VALLEY, CA 92708-3720
(657) 241-3592
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 10513
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA10513
—
CA
Enumeration date
11/18/2005
Last updated
05/26/2016
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