Provider Demographics
NPI:1851806301
Name:GREGOR, ADINA RACHEL (FNP)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:RACHEL
Last Name:GREGOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5546 FOREST COVE LN
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4047
Mailing Address - Country:US
Mailing Address - Phone:818-968-9560
Mailing Address - Fax:
Practice Address - Street 1:5525 ETIWANDA AVE STE 209
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6117
Practice Address - Country:US
Practice Address - Phone:818-344-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily