MEDICARE: GLEN D. JARUS, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	G36924	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124171657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN D. JARUS, M.D., INC.

Provider Business Mailing Address
First Line	:	6319 GREENLEAF AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-3536
Country	:	US
Telephone Number	:	562-945-2468
Fax Number	:	562-945-8804

Provider Business Practice Location Address
First Line	:	6319 GREENLEAF AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-3536
Country	:	US
Telephone Number	:	562-945-2468
Fax Number	:	562-945-8804

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLEN DANIEL JARUS
Credential	:	MD
Telephone Number	:	562-945-2468

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	04/21/2017

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