Healthcare Provider Details

I. General information

NPI: 1396203105
Provider Name (Legal Business Name): GLORIA CECILIA THOMAS ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 05/28/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILMINGTON AVE BUILDING 18 SITE 4D
LOS ANGELES CA
90059
US

IV. Provider business mailing address

12121 WILMINGTON AVE BUILDING 18 SITE 4D
LOS ANGELES CA
90059
US

V. Phone/Fax

Practice location:
  • Phone: 424-444-9050
  • Fax:
Mailing address:
  • Phone: 424-444-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: