| San Gabriel Valley Neurological Medical Group | |
|
767 S Sunset Ave Suite 5 West Covina CA 91790-3546 | |
| (626) 960-4974 | |
| (626) 338-9711 |
| Full Name | San Gabriel Valley Neurological Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 767 S Sunset Ave, West Covina, California |
| Authorized Official Name and Position | Charles L Glatstein (PARTNER) |
| Authorized Official Contact | 6269604974 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Gabriel Valley Neurological Medical Group 767 S Sunset Ave Suite 5 West Covina CA 91790-3546 Ph: (626) 960-4974 | San Gabriel Valley Neurological Medical Group 767 S Sunset Ave Suite 5 West Covina CA 91790-3546 Ph: (626) 960-4974 |
| NPI Number | 1134289093 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134289093 | NPI | - | NPPES |
| 00G307620 | Medicaid | CA | |
| ZZZ74485Z | Medicaid | CA | |
| 00C312740 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | G30762 (California) | Primary |
| 2084N0400X | Psychiatry & Neurology - Neurology | C31274 (California) | Secondary |
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