Individual
JERROLD GLASSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4060 FOURTH AVE, SUITE 650, SAN DIEGO, CA 92103-2116
(619) 819-7222
(619) 299-5023
Mailing address
4060 FOURTH AVE, SUITE 650, SAN DIEGO, CA 92103-2116
(619) 819-7222
(619) 299-5023
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G34309
CA
207RI0011X
Interventional Cardiology Physician
G34309
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G343090
BLUE SHIELD
CA
05
—
00G343090
—
CA
01
—
953712511
TRICARE
CA
Enumeration date
10/04/2006
Last updated
11/04/2010
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