Provider Demographics
NPI:1417088030
Name:GRAY, ROSSLYN YVETTE
Entity Type:Individual
Prefix:
First Name:ROSSLYN
Middle Name:YVETTE
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 1:3800 S. FIGUEROA ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037
Mailing Address - Country:US
Mailing Address - Phone:323-524-0645
Mailing Address - Fax:323-233-5015
Practice Address - Street 1:3800 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1206
Practice Address - Country:US
Practice Address - Phone:323-524-0645
Practice Address - Fax:323-233-5015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator