Provider Demographics
NPI:1154878874
Name:GLAVIANO, KAREY ANN (NMT)
Entity type:Individual
Prefix:
First Name:KAREY
Middle Name:ANN
Last Name:GLAVIANO
Suffix:
Gender:F
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 ALWICK PL
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-7202
Mailing Address - Country:US
Mailing Address - Phone:714-357-9027
Mailing Address - Fax:
Practice Address - Street 1:420 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3001
Practice Address - Country:US
Practice Address - Phone:714-357-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56015174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator