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Contact Information

GLENDALE REJUVENATION MEDICAL GROUP
1703 N AVALON BLVD
WILMINGTON, CA90744-1432
 Phone: 310-233-9355
 Fax: 310-233-2545
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Bariatric Medicine

207QB0002X 08 Physician/Family Practice
 

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Chiropractor - Nutrition

111NN1001X 35 Chiropractic
 

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Physician Assistant

363A00000X 97 Physician Assistant
 

Social Worker

104100000X
 

Sports Medicine

2083S0010X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for GLENDALE REJUVENATION MEDICAL GROUP · (Female)

NPI Number 1073960407
Status Active
Credentials
Entity Individual
Enumeration date 05/16/2016
Last updated 12/21/2021 - About 4 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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