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General NPI Number Information
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NPI Number | 1235257049
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Entity Type | Individual
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Provider Name | DAVID GEORG GLICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16101 VENTURA BLVD STE 240
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City | ENCINO
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State | CA
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Zip | 91436-2513
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Country | US
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Telephone | 818-784-9304
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Fax | 818-784-9307
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Provider Business Mailing Address
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Address Line | 5091 WESTWOOD ST
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City | SIMI VALLEY
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State | CA
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Zip | 93063-0231
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Country | US
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Telephone | 818-784-9304
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Fax | 818-784-9307
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G53604
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License Number State | CA
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