MEDICARE: DR. JOSHUA ROBERT GRECO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	24326	CA

General Provider Information

NPI Number	:	1427291079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA ROBERT GRECO PH.D.

Provider Business Mailing Address
First Line	:	1550 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4819
Country	:	US
Telephone Number	:	805-354-6059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4819
Country	:	US
Telephone Number	:	805-354-6059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	12/16/2011

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