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General NPI Number Information
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NPI Number | 1215349212
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Entity Type | Individual
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Provider Name | GLENN EDWIN HOLT MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2014
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Last Update Date | 05/24/2014
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Provider Practice Location Address
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Address Line | 175 S LENA RD
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0037
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Country | US
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Telephone | 909-387-2542
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Fax | 909-387-2989
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Provider Business Mailing Address
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Address Line | 175 S LENA RD
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0037
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Country | US
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Telephone | 909-387-2542
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Fax | 909-387-2989
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | G70925
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License Number State | CA
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