Provider Demographics
NPI:1922464650
Name:GLORIA, MARY BESS (ND)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BESS
Last Name:GLORIA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-0617
Mailing Address - Country:US
Mailing Address - Phone:971-219-9413
Mailing Address - Fax:
Practice Address - Street 1:1490 COMMERCIAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3800
Practice Address - Country:US
Practice Address - Phone:971-219-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1139175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath