Provider Demographics
NPI:1023341195
Name:GREGORY, CLIFFORD RENE (TRANSPORTATION)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:RENE
Last Name:GREGORY
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3481
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-3481
Mailing Address - Country:US
Mailing Address - Phone:310-419-8112
Mailing Address - Fax:
Practice Address - Street 1:16007 S DENVER AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-2421
Practice Address - Country:US
Practice Address - Phone:310-419-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)