Healthcare Provider Details

I. General information

NPI: 1144630617
Provider Name (Legal Business Name): PHILLIP JOSEPH GLIVAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 200
RIVERSIDE CA
92505-3312
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 200
RIVERSIDE CA
92505-3312
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-1600
  • Fax: 909-557-1732
Mailing address:
  • Phone: 909-557-1600
  • Fax: 909-557-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.151900
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA139186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: