Provider Demographics
NPI:1487359766
Name:MCGREGOR, DWIGHT F (LVN)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:F
Last Name:MCGREGOR
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 W CENTINELA AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8819
Mailing Address - Country:US
Mailing Address - Phone:424-224-0127
Mailing Address - Fax:
Practice Address - Street 1:24930 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2029
Practice Address - Country:US
Practice Address - Phone:310-891-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693996164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse