Individual
DR. JEFFREY A GLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12660 RIVERSIDE DR, SUITE 225, NORTH HOLLYWOOD, CA 91607-3429
(818) 487-0040
(818) 487-0050
Mailing address
5805 SEPULVEDA BLVD, SUITE 610, VAN NUYS, CA 91411-2546
(818) 908-8048
(818) 908-8072
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G58181
CA
207RN0300X
Nephrology Physician
Primary
G58181
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G581810
—
CA
Enumeration date
01/17/2006
Last updated
09/12/2017
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