Glavinovich Medical Corporation

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

Legal business name

GLAVINOVICH MEDICAL CORPORATION

Practice address

456 Panorama Dr
Laguna Beach, CA 92651-1278

Phone

(213) 947-1850

NPI assigned

Oct 22, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Luke GlavinovichNPI 1942220330

Title

Owner

Phone

(949) 307-6210

Specialties & licenses 2

Addresses

Other names 1

• CALIFORNIA REGENERATIVE WOUND CARE Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Luke Glavinovich, M.D.

  • Prevention Professional
  • Irvine, CA
  • NPI 1942220330
  Medicare reassignment NPD Authorized official
• Stephanie J. Jennison, R.N.,N.P.

  • Adult Health Nurse Practitioner
  • Torrance, CA
  • NPI 1851548564
  Medicare reassignment NPD
• Erik Kristopher Smith, PA-C

  • Physician Assistant
  • Lakeport, CA
  • NPI 1396033395
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1033086269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 E CHAPMAN AVE",
            "address_2": "PMB 420",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928693706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 PANORAMA DR",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926511278",
            "telephone_number": "213-947-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLAVINOVICH MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "GLAVINOVICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LUKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-307-6210"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CALIFORNIA REGENERATIVE WOUND CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tamai Poushae Gilbert
• Michele Lee Gillman, LMFT
• Madison Gingold
• Francine Girard, FNP
• Jake Glassman
• Glenn I. Goldberg, D.O., a Professional Medical Corporation
• Glenn I Goldberg, D.O.
• Bram Goldstein, PHD
• Daniela Kassandra Gonzales
• Maria Mercedes Gonzalez-Cook, DDS

• Prevention Professional in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Prevention Professional in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.