Glendale Rejuvenation Medical Group

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

Legal business name

GLENDALE REJUVENATION MEDICAL GROUP

Doing business as

Glendale Rejuvenation Medical Group

Practice address

1703 N Avalon Blvd
Wilmington, CA 90744-1432

Phone

(310) 233-9355

Fax

(310) 233-2545

NPI assigned

May 16, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Eddie Santiago, MANAGER

Title

Manager

Phone

(818) 610-9360

Specialties & licenses 8

Addresses

Other names 1

• Glendale Rejuvenation Medical Group Doing business as

Tax ID family

Glendale Rejuvenation Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Glendale Rejuvenation Medical Group

  • Non-Pharmacy Dispensing Site
  • Wilmington, CA
  • NPI 1457011256
  NPD tax ID

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

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1073960407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441432",
            "telephone_number": "818-518-5980",
            "fax_number": "818-551-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441432",
            "telephone_number": "310-233-9355",
            "fax_number": "310-233-2545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE REJUVENATION MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-16",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-610-9360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glendale Rejuvenation Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glendale Rejuvenation Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mindy Gazula, DMD
• Alexia A Gil, LVN
• Joanne Giron
• Suzitte Daneen Giron
• Alexandra Gjersvold
• Glendale Rejuvenation Medical Group
• Global Medical Clinic
• Karla Jennifer Gomez, DMD
• Rocio Gomez, LVN
• Samuel Gonzalez

• Obesity Medicine (Family Medicine) Physician in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Obesity Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.