| Doctor Name: | GLENN WOLLMAN |
| NPI Number: | 1679801963 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C36169 |
| Business Practice Address: | 1543 Portesuello Ave Santa Barbara, CA - 931054626 |
| Business Phone Number: | 8055695768 |
| Business Fax Number: | 8056873070 |
| Mailing Address: | 1543 Portesuello Ave, SANTA BARBARA |
| State: | CA |
| Postal Code: | 931054626 |
| Phone Number: | 8055695768 |
| Fax Number: | 8056873070 |
| NPI Enumeration Date: | 11/24/2009 |
| NPI Last Update Date: | 11/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C36169 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |