MEDICARE: KATHERINE GLICK

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	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1982551578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE GLICK

Provider Business Mailing Address
First Line	:	1431 W BERKELEY CT
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9890 COUNTY FARM RD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3678
Country	:	US
Telephone Number	:	951-509-8320
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ KATHERINE GLICK ” Practice Location

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