MEDICARE: ELEANOR GLASS RDCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1730562257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR GLASS RDCS

Provider Business Mailing Address
First Line	:	13835 N TATUM BLVD
Second Line	:	SUITE 9-129
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5581
Country	:	US
Telephone Number	:	602-513-0690
Fax Number	:

Provider Business Practice Location Address
First Line	:	13835 N TATUM BLVD
Second Line	:	SUITE 9-129
City	:	PHOENIX
State	:	AZ
Zip	:	85032-5581
Country	:	US
Telephone Number	:	602-513-0690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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