Provider Demographics
NPI:1295846509
Name:FRAY, ROZA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:ROZA
Middle Name:RENEE
Last Name:FRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 W MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 W BENJAMIN HOLT DR
Practice Address - Street 2:D-2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3958
Practice Address - Country:US
Practice Address - Phone:209-477-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16083363LF0000X
CANP 16083363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health