Healthcare Provider Details

I. General information

NPI: 1497143812
Provider Name (Legal Business Name): GLENOAKS MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 GLENOAKS BLVD
SUN VALLEY CA
91352-2801
US

IV. Provider business mailing address

8730 GLENOAKS BLVD
SUN VALLEY CA
91352-2801
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-8811
  • Fax:
Mailing address:
  • Phone: 818-767-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA47749
License Number StateCA

VIII. Authorized Official

Name: MR. GEORGE D FLANIGAN III
Title or Position: OWNER
Credential: MD
Phone: 818-767-8811