Healthcare Provider Details

I. General information

NPI: 1255738100
Provider Name (Legal Business Name): GLORIA QUIOAN NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

IV. Provider business mailing address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8432
  • Fax:
Mailing address:
  • Phone: 310-900-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number320069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: