Glenn Vallecillos, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

A87379 Issued in CA

Practice address

9675 Brighton Way Ste 380
Beverly Hills, CA 90210-5187

Phone

(310) 273-3007

Fax

(310) 733-1818

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642377600000",
    "number": "1902948615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY STE 380",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105187",
            "telephone_number": "310-273-3007",
            "fax_number": "310-733-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY STE 380",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105187",
            "telephone_number": "310-273-3007",
            "fax_number": "310-733-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLECILLOS",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A87379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "39-2063599",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valencia Surgical Center
• Valencia Ultrasound, LLC
• Najla Julie Valentine
• Kathleen Rochelle Valenton, M.D.
• Valia Lifestyle a Medical Corp
• Al Valmadrid, MD
• Nancy Van Der Heide
• Steven Van, PHARMD
• Hilary Vanderschaaf
• Sarah Esther Vanek, LCSW

• Plastic and Reconstructive Surgery Physician in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.