Provider Demographics
NPI:1932483294
Name:GLATSTEIN, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:GLATSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:767 S. SUNSET AVE.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3546
Mailing Address - Country:US
Mailing Address - Phone:626-960-4974
Mailing Address - Fax:626-338-9711
Practice Address - Street 1:767 S. SUNSET AVE.
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3546
Practice Address - Country:US
Practice Address - Phone:626-960-4974
Practice Address - Fax:626-338-9711
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG307622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG30762AMedicare PIN
CAA44537Medicare UPIN