Healthcare Provider Details

I. General information

NPI: 1104620822
Provider Name (Legal Business Name): HOSPITALIST PROGRAM OF GLENDALE MEMORIAL A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CUMBERLAND RD
GLENDALE CA
91202-1308
US

IV. Provider business mailing address

160 CUMBERLAND RD
GLENDALE CA
91202-1308
US

V. Phone/Fax

Practice location:
  • Phone: 818-383-5751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN GALSTYAN
Title or Position: CEO
Credential:
Phone: 818-383-5751