Provider Demographics
NPI:1578656195
Name:JOSEPH N. GREGURICH, M.D.
Entity Type:Organization
Organization Name:JOSEPH N. GREGURICH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:GREGURICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-556-8320
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:#112
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-556-8320
Mailing Address - Fax:714-556-5417
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:#112
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-556-8320
Practice Address - Fax:714-556-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW4671Medicare PIN
CAA40983Medicare UPIN