Healthcare Provider Details

I. General information

NPI: 1649102799
Provider Name (Legal Business Name): MARIA V GORDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N BULLIS RD
COMPTON CA
90221-2209
US

IV. Provider business mailing address

700 N BULLIS RD
COMPTON CA
90221-2209
US

V. Phone/Fax

Practice location:
  • Phone: 310-280-6458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: