Healthcare Provider Details

I. General information

NPI: 1457332512
Provider Name (Legal Business Name): GLENN HAROLD LITTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

IV. Provider business mailing address

1975 SYCAMORE DR
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-955-6352
  • Fax:
Mailing address:
  • Phone: 805-955-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberG70346
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG70346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: