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General NPI Number Information
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NPI Number | 1669410239
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Entity Type | Individual
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Provider Name | THEODORE HENRY GLATZ II M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 18300 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 818-885-5444
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Fax | 818-217-0713
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Provider Business Mailing Address
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Address Line | 5388 ROUND MEADOW RD
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City | HIDDEN HILLS
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State | CA
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Zip | 91302-1165
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Country | US
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Telephone | 818-346-4307
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Fax | 818-346-3379
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | G 30983
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License Number State | CA
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