Provider Demographics
NPI:1043341688
Name:MANCIOCCHI, GLORIA (LVN)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:MANCIOCCHI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920513
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91392-0513
Mailing Address - Country:US
Mailing Address - Phone:818-367-7702
Mailing Address - Fax:
Practice Address - Street 1:14530 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1607
Practice Address - Country:US
Practice Address - Phone:818-373-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN110356164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse