Provider Demographics
NPI:1881031458
Name:GLASS, LEILA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:GLASS DIFELICIANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5018
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:206-551-9275
Mailing Address - Fax:858-966-6733
Practice Address - Street 1:760 WESTWOOD PLZ # C8-749
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4223
Practice Address - Country:US
Practice Address - Phone:424-209-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program