Healthcare Provider Details

I. General information

NPI: 1710478631
Provider Name (Legal Business Name): JULIETTE LOVE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27720 JEFFERSON AVE STE 120
TEMECULA CA
92590-2609
US

IV. Provider business mailing address

713 SAN MARIO DR
SOLANA BEACH CA
92075-1605
US

V. Phone/Fax

Practice location:
  • Phone: 951-587-6973
  • Fax:
Mailing address:
  • Phone: 858-353-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-56057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: