Healthcare Provider Details

I. General information

NPI: 1427224229
Provider Name (Legal Business Name): GREG WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17420 AVALON BLVD 200
CARSON CA
90746-1564
US

IV. Provider business mailing address

6236 BELLE AVE
BUENA PARK CA
90620-4321
US

V. Phone/Fax

Practice location:
  • Phone: 323-759-3464
  • Fax:
Mailing address:
  • Phone: 714-527-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: