Provider Demographics
NPI:1831905140
Name:GLICKMAN, SANDRA R
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:R
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 RIO BRAVO DR
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6648
Mailing Address - Country:US
Mailing Address - Phone:714-318-9466
Mailing Address - Fax:
Practice Address - Street 1:66 S SAN GORGONIO AVE STE 6
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6020
Practice Address - Country:US
Practice Address - Phone:951-922-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker