Provider Demographics
NPI:1629632252
Name:ANDRES, GLADETH GUBAT
Entity Type:Individual
Prefix:MRS
First Name:GLADETH
Middle Name:GUBAT
Last Name:ANDRES
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 1:11036 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2806
Mailing Address - Country:US
Mailing Address - Phone:818-633-9202
Mailing Address - Fax:
Practice Address - Street 1:11036 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2806
Practice Address - Country:US
Practice Address - Phone:818-633-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility