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General NPI Number Information
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NPI Number | 1770828543
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Entity Type | Organization
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Legal Business Name | NIJOLE GLAZE ,M.D.
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 937 S ALVARADO ST STE 1D
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City | LOS ANGELES
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State | CA
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Zip | 90006-3037
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Country | US
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Telephone | 213-385-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 937 S ALVARADO ST STE 1D
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City | LOS ANGELES
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State | CA
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Zip | 90006-3037
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Country | US
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Telephone | 213-385-0016
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. NIJOLE GLAZE
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Credential | M.D
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Telephone | 213-385-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PA14180
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A63700
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License Number State | CA
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