Healthcare Provider Details

I. General information

NPI: 1902220551
Provider Name (Legal Business Name): KIM GLAZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 W. GARVEY AVE. NORTH
WEST COVINA CA
91790
US

IV. Provider business mailing address

4424 COLFAX AVE APT 3
STUDIO CITY CA
91602-1961
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-6061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: