Provider Demographics
NPI:1922856236
Name:DEGREQORIO, JUDITH A (ELECTROLOGIST)
Entity type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:A
Last Name:DEGREQORIO
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 FREMONT BLVD.
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-770-0677
Mailing Address - Fax:
Practice Address - Street 1:4000 FREMONT BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-284-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L2846246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other