Provider Demographics
NPI:1710141155
Name:MACIAS, GLORIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1432 W. VICTORIA AVE.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3324
Mailing Address - Country:US
Mailing Address - Phone:323-887-1989
Mailing Address - Fax:
Practice Address - Street 1:1436 GOODRICH BLVD.
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5103
Practice Address - Country:US
Practice Address - Phone:323-725-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25122103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist