Basic Information
| Provider Information | |||||||||
| NPI: | 1932409281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGORY | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.N., P.H.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W 155TH ST | ||||||||
| Address2: | 103 | ||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902474048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105128111 | ||||||||
| FaxNumber: | 3103242111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W 155TH ST | ||||||||
| Address2: | 103 | ||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902474048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105128111 | ||||||||
| FaxNumber: | 3103242111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2010 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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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 | 163WP0809X | 450740 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.