Provider Demographics
NPI:1255663811
Name:LOERA, GLORIA ALICIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ALICIA
Last Name:LOERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SOUTH SECOND AVENUE
Mailing Address - Street 2:SUITE NUMBER 7
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-332-7122
Mailing Address - Fax:626-966-2799
Practice Address - Street 1:510 S 2ND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3017
Practice Address - Country:US
Practice Address - Phone:626-332-7122
Practice Address - Fax:626-966-2799
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW36182104100000X
CA856991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker