Healthcare Provider Details

I. General information

NPI: 1215131925
Provider Name (Legal Business Name): DR. HOWARD MARK GLUSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S BEVERLY DR STE T
BEVERLY HILLS CA
90212-4303
US

IV. Provider business mailing address

321 S BURNSIDE AVE STE 4B
LOS ANGELES CA
90036-3269
US

V. Phone/Fax

Practice location:
  • Phone: 323-935-9712
  • Fax: 323-935-5775
Mailing address:
  • Phone: 323-935-9712
  • Fax: 323-935-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: