Provider Demographics
NPI:1912243627
Name:CHARLEY, GAY SOPHIA YU (NP)
Entity Type:Individual
Prefix:
First Name:GAY SOPHIA
Middle Name:YU
Last Name:CHARLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAY
Other - Middle Name:SOPHIA
Other - Last Name:CHARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10990 SAN DIEGO MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2417
Mailing Address - Country:US
Mailing Address - Phone:619-528-1245
Mailing Address - Fax:
Practice Address - Street 1:10990 SAN DIEGO MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2417
Practice Address - Country:US
Practice Address - Phone:619-528-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22545363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology