Provider Demographics
NPI:1982312294
Name:GLORIA, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GLORIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 CAMINO CANTERA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3336
Mailing Address - Country:US
Mailing Address - Phone:619-636-4062
Mailing Address - Fax:
Practice Address - Street 1:861 CAMINO CANTERA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3336
Practice Address - Country:US
Practice Address - Phone:619-636-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman