Provider Demographics
NPI:1124363403
Name:RAY, JERMAINE L
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:L
Last Name:RAY
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 1:108 BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4227
Mailing Address - Country:US
Mailing Address - Phone:210-643-4854
Mailing Address - Fax:210-658-4269
Practice Address - Street 1:818 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-4009
Practice Address - Country:US
Practice Address - Phone:210-643-4854
Practice Address - Fax:210-658-4269
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist