Provider Demographics
NPI:1023621778
Name:PINON, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:PINON
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 1:200 BROADWAY ST STE 70
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-2866
Mailing Address - Country:US
Mailing Address - Phone:831-755-4510
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY ST STE 70
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2866
Practice Address - Country:US
Practice Address - Phone:831-755-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program