Provider Demographics
NPI:1144450057
Name:LOPEZ-GLASS, GLORIA ARLENE (PA-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ARLENE
Last Name:LOPEZ-GLASS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:LOPEZ-GLASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:17412 VENTURA BLVD
Mailing Address - Street 2:550
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17412 VENTURA BLVD
Practice Address - Street 2:550
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3827
Practice Address - Country:US
Practice Address - Phone:213-385-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical