Individual
GLADYS SERVIN DE LA MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RSLD
Contact information
Practice address
2138 N TUSTIN ST, ORANGE, CA 92865-3712
(714) 450-4487
(717) 637-0020
Mailing address
11605 N LAMAR BLVD, AUSTIN, TX 78753-2658
(737) 222-6996
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
41106
CA
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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