Provider Demographics
NPI:1669410239
Name:GLATZ, THEODORE HENRY II (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:HENRY
Last Name:GLATZ
Suffix:II
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 1:5388 ROUND MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1165
Mailing Address - Country:US
Mailing Address - Phone:818-346-4307
Mailing Address - Fax:818-346-3379
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-885-5444
Practice Address - Fax:818-217-0713
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 309832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44625Medicare UPIN