Individual
GREGORY T VANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1045 ATLANTIC AVE, SUITE 105, LONG BEACH, CA 90813
(562) 491-9167
(562) 491-7969
Mailing address
1045 ATLANTIC AVE, SUITE 105, LONG BEACH, CA 90813-3408
(562) 491-9167
(562) 491-7969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A32565
CA
2085R0202X
Diagnostic Radiology Physician
Primary
A32565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A325650
—
CA
01
—
HW8412
GROUP PTAN
CA
01
—
HW8412A
PTAN/LEGACY PACIFIC HOSP
CA
01
—
HW8412B
PTAN/LEGACY COMMUNITY HOSP
CA
01
—
HW881
ST MARYS PTAN
CA
Enumeration date
06/05/2006
Last updated
08/20/2018
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