Provider Demographics
NPI:1669179149
Name:GRAY, LISA YURIKA (AUD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:YURIKA
Last Name:GRAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4500
Mailing Address - Country:US
Mailing Address - Phone:310-540-4327
Mailing Address - Fax:310-316-2685
Practice Address - Street 1:4201 TORRANCE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4500
Practice Address - Country:US
Practice Address - Phone:310-540-4327
Practice Address - Fax:310-316-2685
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3746237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter