Healthcare Provider Details

I. General information

NPI: 1154938637
Provider Name (Legal Business Name): GLENN BERDIN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2083
US

IV. Provider business mailing address

23845 MCBEAN PKWY
VALENCIA CA
91355-2083
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-1083
  • Fax: 661-200-1088
Mailing address:
  • Phone: 661-200-1083
  • Fax: 661-200-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95052689
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: