Healthcare Provider Details

I. General information

NPI: 1700243136
Provider Name (Legal Business Name): GLORILYN GOROSPE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 GEORGIA ST SUITE 102
VALLEJO CA
94590-5991
US

IV. Provider business mailing address

236 GEORGIA ST SUITE 102
VALLEJO CA
94590-5991
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-2581
  • Fax: 707-773-5575
Mailing address:
  • Phone: 707-552-2581
  • Fax: 707-773-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: