Healthcare Provider Details

I. General information

NPI: 1962324764
Provider Name (Legal Business Name): CONNER CHASE GREGORIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S BASCOM AVE STE 1112
SAN JOSE CA
95128-3537
US

IV. Provider business mailing address

63 BOVET RD STE 116
SAN MATEO CA
94402-3104
US

V. Phone/Fax

Practice location:
  • Phone: 408-800-7894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: