Provider Demographics
NPI:1033175211
Name:GLOR, RITA (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:GLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 DOWNEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2529
Mailing Address - Country:US
Mailing Address - Phone:562-869-1121
Mailing Address - Fax:562-869-1921
Practice Address - Street 1:11903 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2529
Practice Address - Country:US
Practice Address - Phone:562-869-1121
Practice Address - Fax:562-869-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX67080Medicaid
CAG44803Medicare UPIN
CA20A6708AMedicare ID - Type Unspecified