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NPI Code Detail

MEDICARE: MS. ANGELA GREGORY

MEDICARE:  MS. ANGELA  GREGORY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103TC0700XClinical Psychologist7423OH

General Provider Information

NPI Number : 1811198757
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA GREGORY
Provider Business Mailing Address
First Line : 1124 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4331
Country : US
Telephone Number : 510-533-0800
Fax Number : 510-533-0300
Provider Business Practice Location Address
First Line : 1124 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4331
Country : US
Telephone Number : 510-533-0800
Fax Number : 510-533-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 01/17/2019

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Directions to “ MS. ANGELA GREGORY ” Practice Location

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