Glenn Patrick Tajalle
Specialist/Technologist, Other in Corona, CA. Individual provider (NPI-1).
NPI number1003512971
StatusActive
Last updated in NPPESFeb 2, 2023
Details
- NPI
- 1003512971
- Entity type
- Individual (NPI-1)
- Name
- Mr. Glenn Patrick Tajalle
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 2, 2023
- Certification date
- Feb 2, 2023
- Last updated
- Feb 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246Z00000X | Specialist/Technologist, Other | – | CA | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – |
Practice location
161 Exeter WayCorona, CA 92882-8502
Phone 714-675-9089
Mailing address
161 Exeter WayCorona, CA 92882-8502
Phone 714-675-9089
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