Healthcare Provider Details

I. General information

NPI: 1881031458
Provider Name (Legal Business Name): LEILA GLASS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEILA GLASS DIFELICIANTONIO PHD

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 WILSHIRE BLVD STE 730
BEVERLY HILLS CA
90212-2946
US

IV. Provider business mailing address

9401 WILSHIRE BLVD STE 730
BEVERLY HILLS CA
90212-2946
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-2701
  • Fax: 310-273-1127
Mailing address:
  • Phone: 310-273-2701
  • Fax: 310-273-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number30698
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: