MEDICARE: GLEN DANIEL JARUS 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	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619952306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN DANIEL JARUS MD

Provider Business Mailing Address
First Line	:	6319 S 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 S 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	04/21/2017

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