Provider Demographics
NPI:1427125285
Name:GLUBKA, JAMES L (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:GLUBKA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1448
Mailing Address - Country:US
Mailing Address - Phone:909-946-5752
Mailing Address - Fax:909-694-2370
Practice Address - Street 1:1900 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4614
Practice Address - Country:US
Practice Address - Phone:909-946-5752
Practice Address - Fax:909-694-2370
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN366449367500000X
CA627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28143ZMedicare PIN