Provider Demographics
NPI:1174937551
Name:ASHBY, GREG
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:ASHBY
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 1:5135 DOMENGINE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8291
Mailing Address - Country:US
Mailing Address - Phone:925-755-4777
Mailing Address - Fax:925-755-4777
Practice Address - Street 1:5135 DOMENGINE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8291
Practice Address - Country:US
Practice Address - Phone:925-755-4777
Practice Address - Fax:925-755-4777
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075601460310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility