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General NPI Number Information
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NPI Number | 1033086269
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Entity Type | Organization
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Legal Business Name | GLAVINOVICH MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 456 PANORAMA DR
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1278
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Country | US
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Telephone | 213-947-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 3024 E CHAPMAN AVE PMB 420
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City | ORANGE
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State | CA
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Zip | 92869-3706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN LUKE GLAVINOVICH
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Credential |
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Telephone | 949-307-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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