Provider Demographics
NPI:1700902558
Name:GRECO, DOROTHY A (RN, PHN, BSN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:GRECO
Suffix:
Gender:F
Credentials:RN, PHN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 WONDER LN
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-1523
Mailing Address - Country:US
Mailing Address - Phone:619-334-4307
Mailing Address - Fax:
Practice Address - Street 1:151 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4429
Practice Address - Country:US
Practice Address - Phone:619-401-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597634163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health