Healthcare Provider Details

I. General information

NPI: 1447284682
Provider Name (Legal Business Name): PETER GLEIBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 TORRANCE BLVD SUITE F
TORRANCE CA
90503-5800
US

IV. Provider business mailing address

3475 TORRANCE BLVD SUITE F
TORRANCE CA
90503-5800
US

V. Phone/Fax

Practice location:
  • Phone: 310-543-0395
  • Fax: 310-543-2617
Mailing address:
  • Phone: 310-543-0395
  • Fax: 310-543-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG49444
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG49444
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG49444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: