Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY60534501 | WA |
Y | 103TC0700X | Clinical Psychologist | PY60534501 | WA |
NPI | 1003294703 |
---|---|
Provider Name | Dr. Krystal Gregg |
First Address | Loma Linda, CA 92357-1000 |
Second Address | Loma Linda, CA 92357-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 13/05/2015 |