Healthcare Provider Details

I. General information

NPI: 1811203557
Provider Name (Legal Business Name): GLENN ALLEN THORNTON JR. RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 CAMINO DE LAS PALMAS
LEMON GROVE CA
91945-3334
US

IV. Provider business mailing address

2104 CAMINO DE LAS PALMAS
LEMON GROVE CA
91945-3334
US

V. Phone/Fax

Practice location:
  • Phone: 619-737-6219
  • Fax:
Mailing address:
  • Phone: 619-737-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number00028731
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2278G0305X
TaxonomyGeriatric Care Certified Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: