Provider Demographics
NPI:1194442707
Name:GLOW HEALTH MEDICAL CLINIC
Entity type:Organization
Organization Name:GLOW HEALTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-720-1696
Mailing Address - Street 1:655 IRWIN ST # B1013
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3943
Mailing Address - Country:US
Mailing Address - Phone:415-287-2920
Mailing Address - Fax:
Practice Address - Street 1:655 IRWIN ST # B1013
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3943
Practice Address - Country:US
Practice Address - Phone:415-287-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center