Provider Demographics
NPI:1275927790
Name:GREGOIRE, ASHLEA
Entity Type:Individual
Prefix:
First Name:ASHLEA
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34101 FARENHOLT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-7000
Mailing Address - Country:US
Mailing Address - Phone:619-556-4160
Mailing Address - Fax:
Practice Address - Street 1:USS RUSSELL
Practice Address - Street 2:DDG 59
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96677-1277
Practice Address - Country:US
Practice Address - Phone:619-556-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman