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General NPI Number Information
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NPI Number | 1619095247
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Entity Type | Individual
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Provider Name | BRIAN LESLIE GWARTZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 210 S GRAND AVE 315
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City | GLENDORA
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State | CA
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Zip | 91741-4205
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Country | US
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Telephone | 626-857-7400
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Fax | 626-857-7404
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Provider Business Mailing Address
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Address Line | 210 S GRAND AVE 315
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City | GLENDORA
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State | CA
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Zip | 91741-4205
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Country | US
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Telephone | 626-857-7400
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Fax | 626-857-7404
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A43746
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License Number State | CA
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