Provider Demographics
NPI:1912157645
Name:NIEGAS, GLENN NOEL (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:NOEL
Last Name:NIEGAS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:28582 MALABAR RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1175
Mailing Address - Country:US
Mailing Address - Phone:714-403-1082
Mailing Address - Fax:949-858-1082
Practice Address - Street 1:28582 MALABAR RD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-1175
Practice Address - Country:US
Practice Address - Phone:714-403-1082
Practice Address - Fax:949-858-1082
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A10503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine