Provider Demographics
NPI:1720115256
Name:MASUDA, GLENN ISAO (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ISAO
Last Name:MASUDA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9353 VALLEY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1934
Mailing Address - Country:US
Mailing Address - Phone:626-287-2988
Mailing Address - Fax:626-287-1937
Practice Address - Street 1:9353 VALLEY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1934
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:626-287-1937
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical