Healthcare Provider Details

I. General information

NPI: 1306300843
Provider Name (Legal Business Name): ANNETTE R GREGSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

2721 COPA DE ORO DR
LOS ALAMITOS CA
90720-4911
US

V. Phone/Fax

Practice location:
  • Phone: 562-567-8802
  • Fax:
Mailing address:
  • Phone: 562-912-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License NumberRCP470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: