Provider Demographics
NPI:1659969962
Name:RAY, RITA DARLENE (NP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:DARLENE
Last Name:RAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 ANTON BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7100
Mailing Address - Country:US
Mailing Address - Phone:202-455-0013
Mailing Address - Fax:
Practice Address - Street 1:500 ALAMITOS AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1614
Practice Address - Country:US
Practice Address - Phone:949-304-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine