Healthcare Provider Details

I. General information

NPI: 1700421385
Provider Name (Legal Business Name): CHRISTOPHER ROBERT GLOWACKI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 209-946-3400
  • Fax:
Mailing address:
  • Phone: 214-645-0624
  • Fax: 214-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number38381
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: