MEDICARE: CARL HENRY GREGORY JR.

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	106H00000X	Marriage & Family Therapist	162990	CA

General Provider Information

NPI Number	:	1770354235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL HENRY GREGORY JR.

Provider Business Mailing Address
First Line	:	PO BOX 181411
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92178-1411
Country	:	US
Telephone Number	:	619-987-9237
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 CAMINO DEL RIO S STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4108
Country	:	US
Telephone Number	:	619-458-3944
Fax Number	:

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

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	05/04/2026

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