Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A139186 | CA |
NPI | 1144630617 |
---|---|
Provider Name | Dr. Phillip Joseph Glivar |
First Address | Riverside, CA 92505-3312 |
Second Address | Riverside, CA 92505-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2014 |
Last Update Date | 04/08/2020 |