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General NPI Number Information
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NPI Number | 1558409771
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Entity Type | Individual
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Provider Name | JAGA NATH S GLASSMAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 6534 DWANE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-3927
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Country | US
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Telephone | 858-455-7040
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Fax | 619-462-7049
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Provider Business Mailing Address
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Address Line | 6534 DWANE AVE.
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City | SAN DIEGO
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State | CA
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Zip | 92120-3927
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Country | US
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Telephone | 858-455-7040
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Fax | 619-462-7049
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G55004
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License Number State | CA
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