Basic Information
| Provider Information | |||||||||
| NPI: | 1073834891 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GLEN ABERGEL,MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 LAS POSAS RD STE G | ||||||||
| Address2: | # 202 | ||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930103496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053891553 | ||||||||
| FaxNumber: | 8053891553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 OUTLET CENTER DR | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930360677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054852400 | ||||||||
| FaxNumber: | 8054852455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2010 | ||||||||
| LastUpdateDate: | 06/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | ABERGEL | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER/SOLE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8055730906 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | A067324 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Contractor |
No ID Information.