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General NPI Number Information
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NPI Number | 1386605731
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Entity Type | Organization
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Legal Business Name | RICHARD S. GLUCKMAN M.D. INC
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 1360 W 6TH ST #350
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-832-6428
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Fax | 310-832-5178
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Provider Business Mailing Address
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Address Line | 1360 W 6TH ST #350
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-832-6428
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Fax | 310-832-5178
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | RICHARD STEPHEN GLUCKMAN
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Credential | M.D.
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Telephone | 310-832-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G33891
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License Number State | CA
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