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NPI Code Detail

MEDICARE: GLEN ABERGEL,MD, INC.

MEDICARE: GLEN ABERGEL,MD, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractorA067324CA

General Provider Information

NPI Number : 1073834891
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLEN ABERGEL,MD, INC.
Provider Business Mailing Address
First Line : 2510 LAS POSAS RD STE G
Second Line : # 202
City : CAMARILLO
State : CA
Zip : 93010-3496
Country : US
Telephone Number : 805-389-1553
Fax Number : 805-389-1553
Provider Business Practice Location Address
First Line : 1910 OUTLET CENTER DR
Second Line :
City : OXNARD
State : CA
Zip : 93036-0677
Country : US
Telephone Number : 805-485-2400
Fax Number : 805-485-2455
Authorized Official
Title or Position : SOLE OWNER/SOLE OFFICER
Name : DR. GLEN ABERGEL
Credential : MD
Telephone Number : 805-573-0906
Provider Enumeration Date : 06/16/2010
Last Update Date : 06/16/2010

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Directions to “GLEN ABERGEL,MD, INC. ” Practice Location

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