Active NPI
Glory Cabanilla Tancinco, MD
- Anesthesiology Physician
- Los Angeles, CA
National Provider Identifier
1003033754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- C50519
- Practice address
- 6245 De Longpre Ave
Los Angeles, CA 90028-8253 - Phone
- (234) 622-2713
- NPI assigned
- Apr 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Anesthesiology Physician | 207LP3000X | C50519 | CA | |
| Anesthesiology Physician | 207L00000X | C50519 | CA | Primary |
Addresses
Primary practice location
6245 De Longpre Ave
Los Angeles, CA 90028-8253
Mailing address
PO Box 60790
Pasadena, CA 91116-6790
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C505190 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C50519 | CA | MD | Pediatric Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WK MD Medical Group Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Los Angeles, CA
- NPI 1154802346
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571270400000",
"number": "1003033754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60790",
"city": "PASADENA",
"state": "CA",
"postal_code": "911166790",
"fax_number": "213-413-0327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6245 DE LONGPRE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900288253",
"telephone_number": "234-622-2713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANCINCO",
"first_name": "GLORY",
"middle_name": "CABANILLA",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2019-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "CA",
"license": "C50519",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "C50519",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C505190",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.