Healthcare Provider Details

I. General information

NPI: 1285151613
Provider Name (Legal Business Name): MIA GREGORIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 GATEWAY OAKS DR STE 250
SACRAMENTO CA
95833-4328
US

IV. Provider business mailing address

2890 GATEWAY OAKS DR STE 250
SACRAMENTO CA
95833-4328
US

V. Phone/Fax

Practice location:
  • Phone: 855-421-6831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number735371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: