Healthcare Provider Details

I. General information

NPI: 1831803543
Provider Name (Legal Business Name): RICKIE MCGREGOR LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23925 NEWHALL RANCH RD
VALENCIA CA
91355-5701
US

IV. Provider business mailing address

23904 CALLE DEL SOL DR
VALENCIA CA
91354-3011
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-7551
  • Fax:
Mailing address:
  • Phone: 707-373-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number693262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: