Healthcare Provider Details

I. General information

NPI: 1013959642
Provider Name (Legal Business Name): JEFFREY B GLASER MD MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD SUITE #518
ENCINO CA
91436-2124
US

IV. Provider business mailing address

16311 VENTURA BLVD SUITE #518
ENCINO CA
91436-2124
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7246
  • Fax: 818-501-7247
Mailing address:
  • Phone: 818-501-7246
  • Fax: 818-501-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA64352
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY B GLASER
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 818-744-0505