MEDICARE: GLENN MARK FISCHBERG MD

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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	G83991	CA
2	2084N0400X	Neurology Physician	G83991	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093784951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN MARK FISCHBERG MD

Provider Business Mailing Address
First Line	:	3131 LACANADA STREET
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2592
Country	:	US
Telephone Number	:	702-731-8115
Fax Number	:	702-784-7844

Provider Business Practice Location Address
First Line	:	31700 TEMECULA PKWY
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-5896
Country	:	US
Telephone Number	:	951-331-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/16/2022

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