Provider Demographics
NPI:1144292889
Name:ABLON, GLYNIS REINA (MD)
Entity type:Individual
Prefix:
First Name:GLYNIS
Middle Name:REINA
Last Name:ABLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ROSECRANS AVE
Mailing Address - Street 2:BLDG 6A SUITE 12
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3708
Mailing Address - Country:US
Mailing Address - Phone:310-727-3376
Mailing Address - Fax:310-727-3377
Practice Address - Street 1:1600 ROSECRANS AVE
Practice Address - Street 2:BLDG 6A SUITE 12
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3708
Practice Address - Country:US
Practice Address - Phone:310-727-3376
Practice Address - Fax:310-727-3377
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G772801OtherBLUE SHIELD PIN
CAG77280OtherBLUE CROSS
CA00G772800OtherBLUE SHIELD
CAG77280OtherBLUE CROSS
CA00G772800OtherBLUE SHIELD
CAG39497Medicare UPIN