Provider Demographics
NPI:1871174847
Name:GLORIA, CLARA ELIZABETH
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ELIZABETH
Last Name:GLORIA
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 1:11987 JASMINE PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-2816
Mailing Address - Country:US
Mailing Address - Phone:909-641-3005
Mailing Address - Fax:
Practice Address - Street 1:11987 JASMINE PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-2816
Practice Address - Country:US
Practice Address - Phone:909-641-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider