Provider Demographics
NPI:1154416279
Name:GREGURICH, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GREGURICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7500
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:STE 112
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7500
Practice Address - Country:US
Practice Address - Phone:714-556-8320
Practice Address - Fax:714-556-5417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40983Medicare UPIN