Healthcare Provider Details

I. General information

NPI: 1093694630
Provider Name (Legal Business Name): LENESHA DENAE GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 W FLORIDA AVE # 1042
HEMET CA
92545-3513
US

IV. Provider business mailing address

3381 W FLORIDA AVE # 1042
HEMET CA
92545-3513
US

V. Phone/Fax

Practice location:
  • Phone: 858-815-9182
  • Fax: 858-808-3860
Mailing address:
  • Phone: 858-815-9182
  • Fax: 858-808-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-01005186
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: