Healthcare Provider Details

I. General information

NPI: 1134803604
Provider Name (Legal Business Name): BERYL GWADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13061 MILLER AVE
NORWALK CA
90650-3342
US

IV. Provider business mailing address

13061 MILLER AVE
NORWALK CA
90650-3342
US

V. Phone/Fax

Practice location:
  • Phone: 562-964-3902
  • Fax:
Mailing address:
  • Phone: 562-964-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number737079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: