Individual
DANIEL PETER GLUCKSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
255 E BONITA AVE BLDG 1B, POMONA, CA 91767-1923
(909) 275-7470
(909) 971-4532
Mailing address
310 N INDIAN HILL BLVD, PMB # 801, CLAREMONT, CA 91711-4611
(909) 275-7470
(909) 971-4532
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G56964
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G569640
—
CA
01
—
BK904Z
MEDICARE NO CAL PTAN
—
01
—
G569640
CA STATE LICENSE #
CA
05
—
GR0059670
—
CA
01
—
WG56964B
MEDICARE SO CAL PTAN
—
Enumeration date
06/02/2006
Last updated
08/30/2019
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