Basic Information
| Provider Information | |||||||||
| NPI: | 1093743924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABERGEL | ||||||||
| FirstName: | GLEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 N ROSE AVE STE 220 | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930307640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053848071 | ||||||||
| FaxNumber: | 8059830803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | A67324 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RP1001X | A67324 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0200X | A67324 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A673240 | 05 | CA | MEDICAID |