Healthcare Provider Details

I. General information

NPI: 1730098633
Provider Name (Legal Business Name): GLORIA PORRAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 O SULLIVAN DR
LOS ANGELES CA
90032-4020
US

IV. Provider business mailing address

4921 O SULLIVAN DR
LOS ANGELES CA
90032-4020
US

V. Phone/Fax

Practice location:
  • Phone: 323-610-3713
  • Fax:
Mailing address:
  • Phone: 323-610-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: