Provider Demographics
NPI:1619095247
Name:GWARTZ, BRIAN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LESLIE
Last Name:GWARTZ
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 1:210 S GRAND AVE
Mailing Address - Street 2:315
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4205
Mailing Address - Country:US
Mailing Address - Phone:626-857-7400
Mailing Address - Fax:626-857-7404
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:315
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:626-857-7400
Practice Address - Fax:626-857-7404
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43746207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43746OtherCALIFORNIA
CA00A437461Medicaid
CA00A437461Medicaid
CAA09730Medicare UPIN
CAA09730Medicare UPIN
CAWA43746KMedicare ID - Type UnspecifiedGLENDORA