Provider Demographics
NPI:1962025031
Name:AMBION, GLADYS ANNE CAUSAREN (RPH)
Entity type:Individual
Prefix:MISS
First Name:GLADYS ANNE
Middle Name:CAUSAREN
Last Name:AMBION
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12141 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3503
Mailing Address - Country:US
Mailing Address - Phone:714-400-8679
Mailing Address - Fax:
Practice Address - Street 1:12141 GILBERT ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3503
Practice Address - Country:US
Practice Address - Phone:714-400-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81839183500000X
CA306006272310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No183500000XPharmacy Service ProvidersPharmacist