Provider Demographics
NPI:1063057917
Name:GREGORIO, MARION
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARION
Other - Middle Name:
Other - Last Name:GREGORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27287 BOYD DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6834
Mailing Address - Country:US
Mailing Address - Phone:714-331-1287
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-665-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist