Healthcare Provider Details

I. General information

NPI: 1629779772
Provider Name (Legal Business Name): GREGG GENE DELONG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

1375 E GRAND AVE # 512
ARROYO GRANDE CA
93420-2421
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5244
  • Fax:
Mailing address:
  • Phone: 415-250-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number525921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: