Provider Demographics
NPI:1508622549
Name:PAHARIK, GLADYS MARIA
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:MARIA
Last Name:PAHARIK
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 1:1168 LOIS CIR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4209
Mailing Address - Country:US
Mailing Address - Phone:909-576-9503
Mailing Address - Fax:
Practice Address - Street 1:1168 LOIS CIR
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4209
Practice Address - Country:US
Practice Address - Phone:909-576-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95042109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse