Provider Demographics
NPI:1437125838
Name:SCHLECTER, BRUCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:SCHLECTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-8512
Mailing Address - Fax:
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:#210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-8511
Practice Address - Fax:818-790-8513
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG313912084N0400X, 2084H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G313910OtherCA MEDI-CAL
CA953192779OtherBLUE CROSS OF CA
CA00G313910OtherBLUE SHIELD OF CA
CAA44754Medicare UPIN
CAG31391Medicare ID - Type Unspecified