Individual
GLENN GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 E OCEAN AVE, LOMPOC, CA 93436-7092
(805) 737-3333
Mailing address
801 W OCEAN AVE, LOMPOC, CA 93436-6526
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95364649
CA
Other
Enumeration date
06/01/2026
Last updated
06/01/2026
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