Healthcare Provider Details

I. General information

NPI: 1578475471
Provider Name (Legal Business Name): LAHIRAM GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 CASSIDY ST
OCEANSIDE CA
92054-5314
US

IV. Provider business mailing address

588 N MOLLISON AVE UNIT 11
EL CAJON CA
92021-6182
US

V. Phone/Fax

Practice location:
  • Phone: 760-721-2171
  • Fax:
Mailing address:
  • Phone: 702-742-3056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: