Healthcare Provider Details

I. General information

NPI: 1598908816
Provider Name (Legal Business Name): SUSAN KRISTINA GLABE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PARK CENTER DR STE 100
SACRAMENTO CA
95825-8363
US

IV. Provider business mailing address

2300 MURIETA WAY
SACRAMENTO CA
95822-2832
US

V. Phone/Fax

Practice location:
  • Phone: 916-569-4400
  • Fax: 916-569-4401
Mailing address:
  • Phone: 916-452-0333
  • Fax: 916-451-3769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17081
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPA17081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: