Provider Demographics
NPI:1760704258
Name:CHEN, GLORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 W ROUTE 66
Mailing Address - Street 2:STE 208
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6249
Mailing Address - Country:US
Mailing Address - Phone:626-335-4079
Mailing Address - Fax:626-335-5507
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:STE 208
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-335-4079
Practice Address - Fax:626-335-5507
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant