Provider Demographics
NPI:1467623512
Name:GREGORY J JOY MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GREGORY J JOY MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRENDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-294-0692
Mailing Address - Street 1:26922 OSO PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5800
Mailing Address - Country:US
Mailing Address - Phone:949-582-5430
Mailing Address - Fax:949-348-9513
Practice Address - Street 1:26922 OSO PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5800
Practice Address - Country:US
Practice Address - Phone:949-582-5430
Practice Address - Fax:949-348-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42621Medicare UPIN