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General NPI Number Information
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NPI Number | 1801915327
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Entity Type | Organization
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Legal Business Name | GLENDALE FIDELITY MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 815 E COLORADO ST STE 110A
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City | GLENDALE
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State | CA
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Zip | 91205-1200
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Country | US
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Telephone | 818-242-1910
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Fax | 818-242-1990
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Provider Business Mailing Address
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Address Line | 815 E COLORADO ST STE 110A
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City | GLENDALE
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State | CA
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Zip | 91205-1200
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Country | US
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Telephone | 818-242-1910
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Fax | 818-242-1990
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Authorized Official
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Title or Position | DIRECTOR
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Name | MORIS ELIE
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Credential | MD
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Telephone | 818-242-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1924
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A64420
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A38702
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License Number State | CA
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