Basic Information
| Provider Information | |||||||||
| NPI: | 1881737286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLATLEIDER | ||||||||
| FirstName: | M | ||||||||
| MiddleName: | PAULINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.M. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GLATLEIDER | ||||||||
| OtherFirstName: | POLLI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | C.N.M. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1537 ANGELUS AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900261410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236656591 | ||||||||
| FaxNumber: | 3236650936 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 UCLA MEDICAL PLZ | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107947274 | ||||||||
| FaxNumber: | 3107947436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 367A00000X | NMW 763 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.