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NPI Code Detail

MEDICARE: CARSON GRAY

MEDICARE: CARSON GRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1477449478
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARSON GRAY
Provider Business Mailing Address
First Line : 3994 ROBINWOOD AVE
Second Line :
City : CLOVIS
State : CA
Zip : 93619-7933
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2721 CESAR CHAVEZ BLVD
Second Line :
City : FRESNO
State : CA
Zip : 93721-2366
Country : US
Telephone Number : 559-450-3770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2025
Last Update Date : 06/16/2025

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Directions to “ CARSON GRAY ” Practice Location

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