Provider Demographics
NPI:1386831360
Name:RAY, JON PAUL
Entity Type:Individual
Prefix:
First Name:JON PAUL
Middle Name:
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 1:2900 FRESNO ST
Mailing Address - Street 2:STE108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1439
Mailing Address - Country:US
Mailing Address - Phone:559-486-1869
Mailing Address - Fax:
Practice Address - Street 1:2900 FRESNO ST
Practice Address - Street 2:STE108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1439
Practice Address - Country:US
Practice Address - Phone:559-486-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist