Provider Demographics
NPI:1265604409
Name:VANCE, GLORIA JEAN
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:VANCE
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 1:3606 EXPOSITION BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4822
Mailing Address - Country:US
Mailing Address - Phone:323-298-3568
Mailing Address - Fax:323-298-3549
Practice Address - Street 1:3606 EXPOSITION BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4822
Practice Address - Country:US
Practice Address - Phone:323-298-3568
Practice Address - Fax:323-298-3549
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator