Provider Demographics
NPI:1336773761
Name:GRAYSON, TAMMY RAE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RAE
Last Name:GRAYSON
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 1:3336 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2037
Mailing Address - Country:US
Mailing Address - Phone:925-595-5015
Mailing Address - Fax:
Practice Address - Street 1:3000 CITRUS CIR STE 220
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2665
Practice Address - Country:US
Practice Address - Phone:925-497-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program