Provider Demographics
NPI:1871919852
Name:MEHLMAN, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MEHLMAN
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 1:19725 SHERMAN WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3650
Mailing Address - Country:US
Mailing Address - Phone:818-324-9185
Mailing Address - Fax:818-344-2171
Practice Address - Street 1:19725 SHERMAN WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3650
Practice Address - Country:US
Practice Address - Phone:818-324-9185
Practice Address - Fax:818-344-2171
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293058171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator