Healthcare Provider Details

I. General information

NPI: 1083778286
Provider Name (Legal Business Name): NATANYA S. GLEZER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 10TH AVE
SAN DIEGO CA
92101-6502
US

IV. Provider business mailing address

734 10TH AVE
SAN DIEGO CA
92101-6502
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-4663
  • Fax: 619-239-3045
Mailing address:
  • Phone: 619-239-4663
  • Fax: 619-239-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 24505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: