Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A48553 | CA |
NPI | 1053676619 |
---|---|
Provider Name | Dr. Gladys Hope Dadivas Yerro |
First Address | Van Nuys, CA 91411-1617 |
Second Address | Van Nuys, CA 91411-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 10/07/2012 |