Provider Demographics
NPI:1235253584
Name:DIALYNAS, GLORIA CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:CAROLINA
Last Name:DIALYNAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W CERRITOS AVE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6549
Mailing Address - Country:US
Mailing Address - Phone:714-254-8473
Mailing Address - Fax:714-254-8480
Practice Address - Street 1:4000 W METROPOLITAN DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:866-830-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW1018181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical