Provider Demographics
NPI:1285771857
Name:UMALI, GLENDA FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:FAYE
Last Name:UMALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLENDA
Other - Middle Name:FAYE
Other - Last Name:MATSUMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9127 W RUSSELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1253
Mailing Address - Country:US
Mailing Address - Phone:702-878-0070
Mailing Address - Fax:702-209-2064
Practice Address - Street 1:1600 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-209-2064
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8052207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1285771857Medicaid
NVCC1735OtherBLUE CROSS BLUE SHIELD
NVCC1735OtherBLUE CROSS BLUE SHIELD
NVF64404Medicare UPIN