MEDICARE: MRS. GLORIA MARIE LARES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	110933	TX

General Provider Information

NPI Number	:	1760290456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA MARIE LARES

Provider Business Mailing Address
First Line	:	2409 TIERRA MURCIA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2386
Country	:	US
Telephone Number	:	915-205-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 TIERRA MURCIA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2386
Country	:	US
Telephone Number	:	915-306-1350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	02/20/2026

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