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General NPI Number Information
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NPI Number | 1558097881
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Entity Type | Individual
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Provider Name | DEBORA GREGORY CFNP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 4223 GLENCOE AVE STE B109
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5669
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Country | US
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Telephone | 310-395-4788
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Fax | 310-395-0150
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Provider Business Mailing Address
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Address Line | 4223 GLENCOE AVE STE B109
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5669
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Country | US
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Telephone | 310-395-4788
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Fax | 310-395-0150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10029
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License Number State | CA
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