Healthcare Provider Details

I. General information

NPI: 1497382998
Provider Name (Legal Business Name): NICHOLAS RONALD GREGORIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROADWAY STE 2800
SACRAMENTO CA
95820-1536
US

IV. Provider business mailing address

2315 N ST APT 3
SACRAMENTO CA
95816-5726
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-0870
  • Fax:
Mailing address:
  • Phone: 862-579-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA200776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: