Individual
DR. GLENN VALLECILLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9675 BRIGHTON WAY STE 380, BEVERLY HILLS, CA 90210-5187
(310) 273-3007
(310) 733-1818
Mailing address
9675 BRIGHTON WAY STE 380, BEVERLY HILLS, CA 90210-5187
(310) 273-3007
(310) 733-1818
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
A87379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39-2063599
TAX ID
—
Enumeration date
02/12/2007
Last updated
01/17/2022
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