Provider Demographics
NPI:1457543530
Name:FUNES, GLADIS (MSN/FNP-BC)
Entity Type:Individual
Prefix:
First Name:GLADIS
Middle Name:
Last Name:FUNES
Suffix:
Gender:F
Credentials:MSN/FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4401
Mailing Address - Country:US
Mailing Address - Phone:323-725-1144
Mailing Address - Fax:323-725-1153
Practice Address - Street 1:6007 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4401
Practice Address - Country:US
Practice Address - Phone:323-725-1144
Practice Address - Fax:323-725-1153
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17487Medicare PIN
CA17487Medicare UPIN