Provider Demographics
NPI:1619952306
Name:JARUS, GLEN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:DANIEL
Last Name:JARUS
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 1:6319 S GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3536
Mailing Address - Country:US
Mailing Address - Phone:562-945-2468
Mailing Address - Fax:562-945-8804
Practice Address - Street 1:6319 S GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-3536
Practice Address - Country:US
Practice Address - Phone:562-945-2468
Practice Address - Fax:562-945-8804
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36924207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053740Medicaid
CAGR0053741Medicaid
W11782AMedicare ID - Type Unspecified
CAGR0053740Medicaid
CAGR0053741Medicaid