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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