Provider Demographics
NPI:1629703889
Name:GRAY, LATRINA M
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:M
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 1:2708 EIFFEL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6722
Mailing Address - Country:US
Mailing Address - Phone:214-641-3764
Mailing Address - Fax:
Practice Address - Street 1:3102 MAPLE AVE STE 235
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1325
Practice Address - Country:US
Practice Address - Phone:469-708-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty