MEDICARE: CRAIG RYAN GLUCKMAN MD

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	207RG0100X	Gastroenterology Physician	A160033	CA

General Provider Information

NPI Number	:	1881942506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG RYAN GLUCKMAN MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7345 MEDICAL CENTER DR STE 420
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1964
Country	:	US
Telephone Number	:	818-340-8252
Fax Number	:	818-340-0102

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	09/24/2019

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