Provider Demographics
NPI:1386998508
Name:GLORIA, JOSE RAUL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAUL
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 1:1325 BRIGHTON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-1541
Mailing Address - Country:US
Mailing Address - Phone:210-347-6429
Mailing Address - Fax:210-927-4023
Practice Address - Street 1:1325 BRIGHTON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-1541
Practice Address - Country:US
Practice Address - Phone:210-347-6429
Practice Address - Fax:210-927-4023
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGC-1251171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications