Healthcare Provider Details

I. General information

NPI: 1649315508
Provider Name (Legal Business Name): CASPER GLENN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 WOODBURY DR
HARBOR CITY CA
90710-1241
US

IV. Provider business mailing address

5450 LINCOLN BLVD
PLAYA VISTA CA
90094-2002
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-5054
  • Fax: 424-263-4331
Mailing address:
  • Phone: 310-305-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberA50893
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberG48007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: