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General NPI Number Information
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NPI Number | 1861400780
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Entity Type | Organization
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Legal Business Name | MALCOLM GLEN CORP
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 528 NO PALM AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3218
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Country | US
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Telephone | 909-986-9635
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Fax | 909-391-5873
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Provider Business Mailing Address
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Address Line | 528 NO PALM AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3218
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Country | US
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Telephone | 909-986-9635
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Fax | 909-391-5873
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Authorized Official
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Title or Position | CFO
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Name | MR. GARY M JONES
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Credential | HIS
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Telephone | 909-986-9635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA3682
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License Number State | CA
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