Healthcare Provider Details

I. General information

NPI: 1043011711
Provider Name (Legal Business Name): GREAS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10898 BRYN MAWR AVE
LOMA LINDA CA
92354-4201
US

IV. Provider business mailing address

10898 BRYN MAWR AVE
LOMA LINDA CA
92354-4201
US

V. Phone/Fax

Practice location:
  • Phone: 818-406-6439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GREAS
Title or Position: OWNER/CEO
Credential: MD
Phone: 818-406-6439