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General NPI Number Information
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NPI Number | 1134931785
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Entity Type | Individual
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Provider Name | ELENA VLADIMIROVNA GLASSMAKER FNP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1100 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2606
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Country | US
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Telephone | 818-242-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 SUNNYSIDE RIDGE RD
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-5211
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Country | US
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Telephone | 310-999-3481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95033416
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License Number State | CA
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