MEDICARE: GLENX CARE 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
1	173F00000X	Sleep Specialist (PhD)

General Provider Information

NPI Number	:	1548654973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENX CARE INC

Provider Business Mailing Address
First Line	:	1915 W GLENOAKS BLVD
Second Line	:	STE 101
City	:	GLENDALE
State	:	CA
Zip	:	91201-1541
Country	:	US
Telephone Number	:	818-561-4664
Fax Number	:	818-561-4910

Provider Business Practice Location Address
First Line	:	1915 W GLENOAKS BLVD
Second Line	:	STE 101
City	:	GLENDALE
State	:	CA
Zip	:	91201-1541
Country	:	US
Telephone Number	:	818-561-4664
Fax Number	:	818-561-4910

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VLADYSLAV GUTSUL
Credential	:	OWNER
Telephone Number	:	818-561-4664

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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Directions to “GLENX CARE INC ” Practice Location

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