Provider Demographics
NPI:1730275629
Name:HALEY, GLORIA DEL PILAR (PA-C)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:DEL PILAR
Last Name:HALEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:DEL PILAR
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-1487
Mailing Address - Country:US
Mailing Address - Phone:888-505-0043
Mailing Address - Fax:626-405-4600
Practice Address - Street 1:12815 HEACOCK ST
Practice Address - Street 2:KAISER SOUTHERN CALIFORNIA
Practice Address - City:MORENO
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-601-6174
Practice Address - Fax:951-601-6224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA128190Medicare ID - Type Unspecified