Provider Demographics
NPI:1043888993
Name:GLATT, RYAN MICHAEL (NBC-HWC, CPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:GLATT
Suffix:
Gender:M
Credentials:NBC-HWC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 LA GRANGE AVE APT 424
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6869
Mailing Address - Country:US
Mailing Address - Phone:805-231-7339
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH STREET
Practice Address - Street 2:150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-9006
Practice Address - Country:US
Practice Address - Phone:805-231-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA