Individual
TAMIKO GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Mailing address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT35657
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760651178
—
CA
Enumeration date
05/12/2016
Last updated
08/12/2025
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