Provider Information for 1811211832
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GLENN DOTY
Sex: Male
NPI: 1811211832
Last Updated: 2025-03-26
Certification Date: 2025-03-24
Certification Date: 2025-03-24
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1811211832 | ||||||||
| Enumeration Date | 2010-03-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3666 VALLEY VIEW AVE NORCO, CA 92860-1369 United States Phone: 951-545-2028 | Fax: | ||||||||
| Primary Practice Address | 3666 VALLEY VIEW AVE NORCO, CA 92860-1369 United States Phone: 951-545-2028 | Fax: | ||||||||
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