Organization
GLENN TISMAN M D A MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN TISMAN (DOCTOR)
(562) 789-8822
Entity
Organization
Contact information
Practice address
13025 BAILEY ST, WHITTIER, CA 90601-4211
(562) 789-8822
Mailing address
13025 BAILEY ST, WHITTIER, CA 90601-4211
Taxonomy
Speciality
Code
Description
License number
State
261QX0200X
Oncology Clinic/Center
Primary
G19173A
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ59344Z
BLUE SHIELD
CA
Enumeration date
07/10/2006
Last updated
08/15/2008
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