Provider Demographics
NPI:1962735381
Name:PAYNE, GLENN JOSEPH (CRT)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:JOSEPH
Last Name:PAYNE
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E PHILADELPHIA ST
Mailing Address - Street 2:9207
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4810
Mailing Address - Country:US
Mailing Address - Phone:909-781-5406
Mailing Address - Fax:
Practice Address - Street 1:1110 E PHILADELPHIA ST
Practice Address - Street 2:9207
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4810
Practice Address - Country:US
Practice Address - Phone:909-781-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00018987225B00000X, 2278G1100X, 2278P1004X, 2278P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function Technologist
No225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function Technologist
No2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics