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General NPI Number Information
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NPI Number | 1609989425
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Entity Type | Organization
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Legal Business Name | GLENDALE RETINA ASSOCIATES MEDICAL GROUP INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1025 N BRAND BLVD SUITE 200
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City | GLENDALE
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State | CA
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Zip | 91202-2950
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Country | US
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Telephone | 818-230-2140
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Fax | 818-230-2148
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Provider Business Mailing Address
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Address Line | 1025 N BRAND BLVD SUITE 200
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City | GLENDALE
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State | CA
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Zip | 91202-2950
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Country | US
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Telephone | 818-230-2140
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Fax | 818-230-2148
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANJAY LOGANI
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Credential | MD
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Telephone | 818-886-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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