Healthcare Provider Details

I. General information

NPI: 1881737286
Provider Name (Legal Business Name): M PAULINE GLATLEIDER C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POLLI GLATLEIDER C.N.M.

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ SUITE 430
LOS ANGELES CA
90095-8344
US

IV. Provider business mailing address

1537 ANGELUS AVE
LOS ANGELES CA
90026-1410
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7274
  • Fax: 310-794-7436
Mailing address:
  • Phone: 323-665-6591
  • Fax: 323-665-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW 763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: