Healthcare Provider Details

I. General information

NPI: 1508063488
Provider Name (Legal Business Name): GLORIA LOUISE CAUDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 800-854-7771
  • Fax:
Mailing address:
  • Phone: 310-918-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: