Healthcare Provider Details

I. General information

NPI: 1730275629
Provider Name (Legal Business Name): GLORIA DEL PILAR HALEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA DEL PILAR SHERMAN PA-C

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 HEACOCK ST KAISER SOUTHERN CALIFORNIA
MORENO CA
92553
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR
PASADENA CA
91188-1487
US

V. Phone/Fax

Practice location:
  • Phone: 951-601-6174
  • Fax: 951-601-6224
Mailing address:
  • Phone: 888-505-0043
  • Fax: 626-405-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: