Provider Demographics
NPI:1073720546
Name:GREGORY, ROSANNA VICTORIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:VICTORIA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ROSANNA
Other - Middle Name:VICTORIA
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2832 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3211
Mailing Address - Country:US
Mailing Address - Phone:714-532-2837
Mailing Address - Fax:714-532-2917
Practice Address - Street 1:2832 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3211
Practice Address - Country:US
Practice Address - Phone:714-532-2837
Practice Address - Fax:714-532-2917
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA10948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist