Organization
GLENN P. WEDEEN MD A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN P WEDEEN M.D. (PRESIDENT)
(626) 357-8535
Entity
Organization
Contact information
Practice address
15248 11TH ST, VICTORVILLE, CA 92395-3704
(760) 245-8691
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
(949) 643-3345
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G75574
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G75574
STATE LICENSE
CA
Enumeration date
01/29/2007
Last updated
08/22/2020
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