MEDICARE: DR. GLENN A PASTERNACK MD

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	208600000X	Surgery Physician	G39086	CA
2	2086S0129X	Vascular Surgery Physician	G39086	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	:	1356453518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN A PASTERNACK MD

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE
Second Line	:	SUITE 602
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2748
Country	:	US
Telephone Number	:	310-558-8063
Fax Number	:	310-204-6556

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE
Second Line	:	SUITE 602
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2748
Country	:	US
Telephone Number	:	310-558-8063
Fax Number	:	310-204-6556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/08/2008

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