Individual
DR. CLARENCE GLENN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Mailing address
702 S ST ANDREWS PL APT 8, LOS ANGELES, CA 90005-3145
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A167345
CA
2084P0800X
Psychiatry Physician
Primary
A167345
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/09/2018
Last updated
07/05/2023
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