Provider Demographics
NPI:1437184876
Name:GREGORIO, FEDERICO PARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:PARDO
Last Name:GREGORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1000 S NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-6300
Mailing Address - Country:US
Mailing Address - Phone:432-943-7887
Mailing Address - Fax:432-943-4505
Practice Address - Street 1:199 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2954
Practice Address - Country:US
Practice Address - Phone:530-458-3283
Practice Address - Fax:530-458-3215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50507208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505070Medicaid
CAD94008Medicare UPIN
CA00A505071Medicare PIN