Provider Demographics
NPI:1891753513
Name:ROBERT L. RAY
Entity Type:Organization
Organization Name:ROBERT L. RAY
Other - Org Name:ROBERT L. RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-617-1394
Mailing Address - Street 1:31 W ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3404
Mailing Address - Country:US
Mailing Address - Phone:209-726-3846
Mailing Address - Fax:209-726-3085
Practice Address - Street 1:31 W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3404
Practice Address - Country:US
Practice Address - Phone:209-726-3846
Practice Address - Fax:209-726-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10756291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00957ZMedicare ID - Type UnspecifiedPROVIDER #