Provider Demographics
NPI:1861884132
Name:HERNANDEZ SILERIO, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:HERNANDEZ SILERIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 E ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2348
Mailing Address - Country:US
Mailing Address - Phone:619-420-1378
Mailing Address - Fax:619-420-1331
Practice Address - Street 1:584 E ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2348
Practice Address - Country:US
Practice Address - Phone:619-420-1378
Practice Address - Fax:619-420-1331
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist