Provider Demographics
NPI:1295446342
Name:LABRADOR, GLORIA LORENZO (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:LORENZO
Last Name:LABRADOR
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 ROYAL OAK DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1950
Mailing Address - Country:US
Mailing Address - Phone:360-491-6497
Mailing Address - Fax:360-491-6497
Practice Address - Street 1:7801 ROYAL OAK DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98503-1950
Practice Address - Country:US
Practice Address - Phone:360-491-6497
Practice Address - Fax:360-491-6497
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA592800311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home