Basic Information
| Provider Information | |||||||||
| NPI: | 1285839852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLAZIER | ||||||||
| FirstName: | EVE | ||||||||
| MiddleName: | MAGDALEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103194377 | ||||||||
| FaxNumber: | 3103194425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 16TH ST | ||||||||
| Address2: | STE 125 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103194377 | ||||||||
| FaxNumber: | 3103194425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A93608 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A936080 | 05 | CA | MEDICAID |