Healthcare Provider Details

I. General information

NPI: 1447217781
Provider Name (Legal Business Name): GLENN FRANCIS VRABEL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE 10TH FLOOR
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE 10TH FLOOR
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-305-3030
  • Fax:
Mailing address:
  • Phone: 213-305-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 20352
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 20352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: