Provider Demographics
NPI:1114179843
Name:GRAY, ERIC LEE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1400
Mailing Address - Country:US
Mailing Address - Phone:213-236-9388
Mailing Address - Fax:213-489-7993
Practice Address - Street 1:605 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1400
Practice Address - Country:US
Practice Address - Phone:213-236-9388
Practice Address - Fax:213-489-7993
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator