Provider Demographics
NPI:1770998445
Name:GLORIA, JOANNE MARIE D (PA)
Entity type:Individual
Prefix:
First Name:JOANNE MARIE
Middle Name:D
Last Name:GLORIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:814 MARYANN DR APT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5057
Mailing Address - Country:US
Mailing Address - Phone:408-881-3343
Mailing Address - Fax:
Practice Address - Street 1:814 MARYANN DR APT 6
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5057
Practice Address - Country:US
Practice Address - Phone:408-881-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant