Provider Demographics
NPI:1275171522
Name:HEINRICHS, GLORIA ROMERO
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ROMERO
Last Name:HEINRICHS
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 1:10417 PERSEPHONE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-2216
Mailing Address - Country:US
Mailing Address - Phone:915-329-5554
Mailing Address - Fax:
Practice Address - Street 1:10417 PERSEPHONE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-2216
Practice Address - Country:US
Practice Address - Phone:915-329-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148621310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility