| Doctor Name: | MR. GREGORY AIFEHIENGBE IDONI |
| NPI Number: | 1003231523 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 107206634 |
| Business Practice Address: | 3618 W Dayton Ave Fresno, CA - 937224704 |
| Business Phone Number: | 5592752488 |
| Business Fax Number: | 5592752488 |
| Mailing Address: | 3618 W Dayton Ave, FRESNO |
| State: | CA |
| Postal Code: | 937224704 |
| Phone Number: | 5592752488 |
| Fax Number: | 5592752488 |
| NPI Enumeration Date: | 02/19/2014 |
| NPI Last Update Date: | 02/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 376G00000X |
| License Number: | 107206634 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Nursing Home Administrator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual, often licensed by the state, who is responsible for the management of a nursing home. |