Provider Demographics
NPI:1215187224
Name:GREGORIO, CORAZON SM (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:SM
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 IRON OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3058
Mailing Address - Country:US
Mailing Address - Phone:702-715-1354
Mailing Address - Fax:
Practice Address - Street 1:7195 IRON OAK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3058
Practice Address - Country:US
Practice Address - Phone:702-715-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist