=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366509366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN THOMAS OZALAN N.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 01/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9360 E RAINTREE DR TIME4HEALTH STE #101
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-380-5518
-----------------------------------------------------
Fax | 623-298-5644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2138 W MYRTLE AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85021-7770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-380-5518
-----------------------------------------------------
Fax | 623-298-5644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 78-324
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------