Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G79524 | CA |
Y | 111NI0900X | Internist | G79524 | CA |
N | 207RA0401X | Internist - Addiction Medicine | G79524 | CA |
NPI | 1649228917 |
---|---|
Provider Name | Dr. Daniel Jay Glatt |
First Address | Burlingame, CA 94010 |
Second Address | Burlingame, CA 94010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G795240 | (05) | CA |
H51727 | (02) |