Provider Demographics
NPI:1194049619
Name:LEGASPI, GLENN ESTACIO
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:ESTACIO
Last Name:LEGASPI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 S ALVARADO ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4075
Mailing Address - Country:US
Mailing Address - Phone:213-252-8981
Mailing Address - Fax:213-252-8214
Practice Address - Street 1:819 S ALVARADO ST
Practice Address - Street 2:STE. 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4075
Practice Address - Country:US
Practice Address - Phone:213-252-8981
Practice Address - Fax:213-252-8214
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001605251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059050Medicare UPIN