Provider Demographics
NPI:1881035913
Name:GRAY, LORRAINE KULHANEK (RD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:KULHANEK
Last Name:GRAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2492
Mailing Address - Country:US
Mailing Address - Phone:626-355-3443
Mailing Address - Fax:626-355-7843
Practice Address - Street 1:147 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2492
Practice Address - Country:US
Practice Address - Phone:626-355-3443
Practice Address - Fax:626-355-7843
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD 525391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered