Healthcare Provider Details

I. General information

NPI: 1366509366
Provider Name (Legal Business Name): GLENN THOMAS OZALAN N.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9360 E RAINTREE DR TIME4HEALTH STE #101
SCOTTSDALE AZ
85260-2099
US

IV. Provider business mailing address

2138 W MYRTLE AVE
PHOENIX AZ
85021-7770
US

V. Phone/Fax

Practice location:
  • Phone: 602-380-5518
  • Fax: 623-298-5644
Mailing address:
  • Phone: 602-380-5518
  • Fax: 623-298-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number78-324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: