Provider Demographics
NPI:1154590776
Name:GLORIA, WENDELL
Entity type:Individual
Prefix:MR
First Name:WENDELL
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 1:12212 VIARNA ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7728
Mailing Address - Country:US
Mailing Address - Phone:562-644-7603
Mailing Address - Fax:
Practice Address - Street 1:12212 VIARNA ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7728
Practice Address - Country:US
Practice Address - Phone:562-644-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program