Healthcare Provider Details

I. General information

NPI: 1932409281
Provider Name (Legal Business Name): JANICE GREGORY R.N., P.H.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 155TH ST 103
GARDENA CA
90247-4048
US

IV. Provider business mailing address

1300 W 155TH ST 103
GARDENA CA
90247-4048
US

V. Phone/Fax

Practice location:
  • Phone: 310-512-8111
  • Fax: 310-324-2111
Mailing address:
  • Phone: 310-512-8111
  • Fax: 310-324-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number450740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: