Healthcare Provider Details

I. General information

NPI: 1578220026
Provider Name (Legal Business Name): GL CA CLIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 STEWART AVE STE 108
FREMONT CA
94538-3100
US

IV. Provider business mailing address

5500 STEWART AVE STE 108
FREMONT CA
94538-3100
US

V. Phone/Fax

Practice location:
  • Phone: 510-203-6087
  • Fax:
Mailing address:
  • Phone: 510-203-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: HERJIT SINGH
Title or Position: CEO
Credential:
Phone: 800-790-4550