Provider Demographics
NPI:1154912640
Name:VOUROS, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:VOUROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 EL AGUILA LN # NA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4332
Mailing Address - Country:US
Mailing Address - Phone:760-519-7981
Mailing Address - Fax:
Practice Address - Street 1:2602 EL AGUILA LN # NA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4332
Practice Address - Country:US
Practice Address - Phone:760-519-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist