Provider Demographics
NPI:1215578224
Name:GRAY, VALERIE JEAN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-4107
Mailing Address - Country:US
Mailing Address - Phone:562-253-5139
Mailing Address - Fax:562-826-5718
Practice Address - Street 1:807 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-4107
Practice Address - Country:US
Practice Address - Phone:562-253-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider