Provider Demographics
NPI:1740510718
Name:JOHN, GLORIA SR (MSN)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:SR
Last Name:JOHN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 WINNING COLORS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2515
Mailing Address - Country:US
Mailing Address - Phone:210-452-2077
Mailing Address - Fax:210-479-5740
Practice Address - Street 1:2330 WINNING COLORS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248
Practice Address - Country:US
Practice Address - Phone:210-452-2077
Practice Address - Fax:210-479-5740
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide