Healthcare Provider Details

I. General information

NPI: 1699809251
Provider Name (Legal Business Name): PRISCA GLOOR MAUNG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRISCA GLOOR PH. D.

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

4055 COOLIDGE AVE
LOS ANGELES CA
90066-5411
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-1666
  • Fax:
Mailing address:
  • Phone: 310-313-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRPS2006159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: