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Glenn Petillo
NPI 1770936635 · on the registry since 2016
Practice
- Address
- 37802 Fischer Rd
Anza, CA 92539 - Phone
- (951) 551-3204
Registry record
- Primary taxonomy
- 376K00000X
376K00000X
- Also registered as
- 374U00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2016-07-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California