1013423243 NPI number — MR. MICHAEL PHILLIP GLAZER RBT

Table of content: MR. MICHAEL PHILLIP GLAZER RBT (NPI 1013423243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013423243 NPI number — MR. MICHAEL PHILLIP GLAZER RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLAZER
Provider First Name:
MICHAEL
Provider Middle Name:
PHILLIP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013423243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-1221 KA UKA BLVD., UNIT 108
Provider Second Line Business Mailing Address:
#167
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94-1221 KA UKA BLVD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-6299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-292-7968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-16-14539 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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