Healthcare Provider Details

I. General information

NPI: 1518487388
Provider Name (Legal Business Name): GLORIA VIADO CUEVILLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3446
  • Fax: 310-222-6470
Mailing address:
  • Phone: 310-222-3446
  • Fax: 310-222-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number713549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: