Basic Information
| Provider Information | |||||||||
| NPI: | 1528278678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIDLEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23294 SINGLE OAK WAY | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925629358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515055375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9985 SIERRA AVE | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923356720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094273910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A82705 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.