Provider Demographics
NPI:1982264750
Name:GLORIA, JOHN PATRICK AZUCENA (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN PATRICK
Middle Name:AZUCENA
Last Name:GLORIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 RADIANT WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8736
Mailing Address - Country:US
Mailing Address - Phone:973-262-0986
Mailing Address - Fax:
Practice Address - Street 1:3016 RADIANT WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-8736
Practice Address - Country:US
Practice Address - Phone:973-262-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01775900225100000X
CA296734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist