Healthcare Provider Details

I. General information

NPI: 1962974576
Provider Name (Legal Business Name): GLASGOW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR BLDG 39, 1ST FLOOR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

18521 ROBIN WAY
VILLA PARK CA
92861-2751
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECA LAGUNA
Title or Position: ADMIN/BILLING MANAGER
Credential:
Phone: 442-600-5128