Provider Demographics
NPI:1609583392
Name:SIAUMAU, GREGORY (PMHNP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SIAUMAU
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 CUYAMACA ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4289
Mailing Address - Country:US
Mailing Address - Phone:619-596-9890
Mailing Address - Fax:
Practice Address - Street 1:8770 CUYAMACA ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4289
Practice Address - Country:US
Practice Address - Phone:619-596-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95031610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty