Basic Information
| Provider Information | |||||||||
| NPI: | 1063057917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGORIO | ||||||||
| FirstName: | MARION | ||||||||
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| OtherLastName: | GREGORIO | ||||||||
| OtherFirstName: | MARION | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 27287 BOYD DR | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925846834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143311287 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1695 S SAN JACINTO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925835103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516651510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2019 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 29572 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.