Healthcare Provider Details

I. General information

NPI: 1275783011
Provider Name (Legal Business Name): GLENN R. SALTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 SOQUEL DR SUITE 203
APTOS CA
95003-4034
US

IV. Provider business mailing address

9053 SOQUEL DR SUITE 203
APTOS CA
95003-4034
US

V. Phone/Fax

Practice location:
  • Phone: 831-661-0365
  • Fax: 831-688-6779
Mailing address:
  • Phone: 831-661-0365
  • Fax: 831-688-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG85441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: