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General NPI Number Information
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NPI Number | 1285566752
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Entity Type | Individual
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Provider Name | GLENN GILLEN
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Gender | Male
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 1515 E OCEAN AVE
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City | LOMPOC
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State | CA
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Zip | 93436-7092
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Country | US
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Telephone | 805-737-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W OCEAN AVE
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City | LOMPOC
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State | CA
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Zip | 93436-6526
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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 |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95364649
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License Number State | CA
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