Provider Demographics
NPI:1972893493
Name:BRUCE M SCHLECTER, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRUCE M SCHLECTER, M.D. PROFESSIONAL CORPORATION
Other - Org Name:BRUCE M SCHLECTER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHLECTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-790-8511
Mailing Address - Street 1:1809 VERDUGO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-8511
Mailing Address - Fax:818-790-8513
Practice Address - Street 1:1809 VERDUGO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-8511
Practice Address - Fax:818-790-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44754Medicare UPIN