Healthcare Provider Details

I. General information

NPI: 1609253392
Provider Name (Legal Business Name): GLBESC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 WORSHAM AVE STE 200
LONG BEACH CA
90808
US

IV. Provider business mailing address

3833 WORSHAM AVE STE 200
LONG BEACH CA
90808-1766
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-2606
  • Fax:
Mailing address:
  • Phone: 562-426-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES HOGAN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 562-426-2606