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General NPI Number Information
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NPI Number | 1205207594
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Entity Type | Individual
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Provider Name | VINCENT ANGELO GLAVIANO NP
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Gender | Male
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 12746 W JEFFERSON BLVD STE 3000
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City | LOS ANGELES
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State | CA
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Zip | 90094-2885
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Country | US
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Telephone | 424-315-2395
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Fax | 424-315-2396
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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Country | US
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Telephone | 424-315-2395
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Fax | 424-315-2396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2295490
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95017783
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License Number State | CA
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