Provider Demographics
NPI:1770828543
Name:NIJOLE GLAZE ,M.D.
Entity Type:Organization
Organization Name:NIJOLE GLAZE ,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIJOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-385-0016
Mailing Address - Street 1:937 S ALVARADO ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3037
Mailing Address - Country:US
Mailing Address - Phone:213-385-0016
Mailing Address - Fax:
Practice Address - Street 1:937 S ALVARADO ST STE 1D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3037
Practice Address - Country:US
Practice Address - Phone:213-385-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63700207R00000X
CAPA14180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty