Provider Demographics
NPI:1326852310
Name:GARCIA LOPEZ, GLADYS YAZMIN
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:YAZMIN
Last Name:GARCIA LOPEZ
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 1:83695 COXCOMB DR
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-6813
Mailing Address - Country:US
Mailing Address - Phone:760-619-8641
Mailing Address - Fax:
Practice Address - Street 1:1080 MARINA VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6427
Practice Address - Country:US
Practice Address - Phone:510-418-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program