Stream, Glen R
Stream, Glen R is an individual health care provider with primary practice located at 45280 Seeley Dr 3Rd Floor E-365, La Quinta CA 92253-6834. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Stream, Glen R can be contacted via phone (760) 610-7300.Contact Information
Primary practice address
45280 Seeley Dr 3Rd Floor E-365
La Quinta CA 92253-6834
Phone: (760) 610-7300
Fax: (760) 610-7301
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD00021005 | Washington |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | G89420 | California |
Profile Details
| NPI number | 1265425326 |
|---|---|
| LBN Legal business name | Stream, Glen R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2005 |
| Last updated | Mar 1st, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265425326 | NPPES |
| Washington | MEDICAID | 8506404 |
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