Provider Demographics
NPI:1356489769
Name:LARA-VASQUEZ, GLORIA LINDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LINDA
Last Name:LARA-VASQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 MARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4125
Mailing Address - Country:US
Mailing Address - Phone:323-223-0423
Mailing Address - Fax:
Practice Address - Street 1:550 S VERMONT AVE FL 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-739-7372
Practice Address - Fax:213-351-2491
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN250196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse