Healthcare Provider Details

I. General information

NPI: 1053848176
Provider Name (Legal Business Name): ALISHA GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD # O
SANTEE CA
92071-3027
US

IV. Provider business mailing address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3027
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: