Provider Demographics
NPI:1750739173
Name:PARRA, GLORIA (FNP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:PARRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CLIFFWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3629
Mailing Address - Country:US
Mailing Address - Phone:310-351-3765
Mailing Address - Fax:
Practice Address - Street 1:451 CLIFFWOOD AVE
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3629
Practice Address - Country:US
Practice Address - Phone:310-351-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily