Provider Demographics
NPI:1548353956
Name:ARDIGO, GREGORY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:ARDIGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40404 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5786
Mailing Address - Country:US
Mailing Address - Phone:951-600-0288
Mailing Address - Fax:951-600-0188
Practice Address - Street 1:40404 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE C
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5786
Practice Address - Country:US
Practice Address - Phone:951-600-0288
Practice Address - Fax:951-600-0188
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77405Medicare UPIN
CA00G759430Medicare ID - Type UnspecifiedMEDICARE NUMBER