Provider Demographics
NPI:1477379592
Name:ORAY, VIVIAN ACHIENG (AGNP-C)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ACHIENG
Last Name:ORAY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 BENT TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4158
Mailing Address - Country:US
Mailing Address - Phone:619-457-8849
Mailing Address - Fax:
Practice Address - Street 1:564 BENT TRAIL DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4158
Practice Address - Country:US
Practice Address - Phone:619-457-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG10240073363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care