Healthcare Provider Details

I. General information

NPI: 1255377495
Provider Name (Legal Business Name): LAWRENCE DAVID GLUCKSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N WIGET LN # B
WALNUT CREEK CA
94598-2408
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 925-378-4930
  • Fax: 925-627-3560
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-347-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG60407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: