=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588370415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRIS GLUZMAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2023
-----------------------------------------------------
Last Update Date | 01/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17150 EUCLID ST STE 200
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-497-3033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13217 JAMBOREE RD # 514
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92782-9158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-497-3033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | IRIS GLUZMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-412-9864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------