Healthcare Provider Details

I. General information

NPI: 1104798529
Provider Name (Legal Business Name): GLORIALYZ DELOSSANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/06/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S MAYFLOWER AVE SUITE 220
MONROVIA CA
91016-4066
US

IV. Provider business mailing address

300 MAIN STREET
MILFORD MA
01757
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 888-588-2752
Mailing address:
  • Phone: 508-478-0207
  • Fax: 508-634-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: