Organization
GLENVILLE MEDICAL GROUP, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOY VERNON (BILLER)
(310) 551-2750
Entity
Organization
Contact information
Practice address
1531 GLENVILLE DR, LOS ANGELES, CA 90035-3107
(310) 551-2750
Mailing address
1531 GLENVILLE DR, LOS ANGELES, CA 90035-3107
(310) 551-2750
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
09/21/2007
Last updated
12/26/2007
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