Individual
LAURENCE GLENN YELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5555 RESERVOIR DRIVE, SUITE 209, SAN DIEGO, CA 92120-5186
(619) 582-2404
(619) 582-2915
Mailing address
5555 RESERVOIR DRIVE, SUITE 209, SAN DIEGO, CA 92120-5186
(619) 582-2404
(619) 582-2915
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G015453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G015453
STATE LICENSE
CA
05
—
ZZZ74366
—
CA
Enumeration date
02/27/2007
Last updated
03/07/2023
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