MEDICARE: DR. GLENN HOWARD PERELSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G63071	CA

General Provider Information

NPI Number	:	1972506970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN HOWARD PERELSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 606
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91976-0606
Country	:	US
Telephone Number	:	619-460-3109
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 BAY BLVD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-5254
Country	:	US
Telephone Number	:	619-498-6423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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