Provider Demographics
NPI:1598145278
Name:GRAY, MAUREEN (CCP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4240 LOST HILLS RD
Mailing Address - Street 2:UNIT #1602
Mailing Address - City:CALABASAS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5345
Mailing Address - Country:US
Mailing Address - Phone:310-871-7264
Mailing Address - Fax:
Practice Address - Street 1:4240 LOST HILLS RD
Practice Address - Street 2:UNIT #1602
Practice Address - City:CALABASAS HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5345
Practice Address - Country:US
Practice Address - Phone:310-871-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA870055242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist