Organization
CA FIDELIS PC
Active
Organization
CA FIDELIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN A HALVORSON M.D. (MEDICAL DIRECTOR)
(877) 408-2488
Entity
Organization
Contact information
Practice address
11726 SAN VICENTE BLVD, SUITE 414, LOS ANGELES, CA 90049-5044
(877) 408-2488
(866) 776-6641
Mailing address
11726 SAN VICENTE BLVD, SUITE 414, LOS ANGELES, CA 90049-5044
(877) 408-2488
(866) 776-6641
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G75477
CA
Other
Enumeration date
11/22/2011
Last updated
03/27/2012
Update your record
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