Provider Demographics
NPI:1932409281
Name:GREGORY, JANICE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W 155TH ST
Mailing Address - Street 2:103
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4048
Mailing Address - Country:US
Mailing Address - Phone:310-512-8111
Mailing Address - Fax:310-324-2111
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:103
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4048
Practice Address - Country:US
Practice Address - Phone:310-512-8111
Practice Address - Fax:310-324-2111
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450740163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult