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NPI Code Detail

MEDICARE: RITA DARLENE RAY NP

MEDICARE: RITA DARLENE RAY NP
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
1207Q00000XFamily Medicine Physician95015627CA

General Provider Information

NPI Number : 1659969962
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA DARLENE RAY NP
Provider Business Mailing Address
First Line : 600 ANTON BLVD
Second Line : STE 1100
City : COSTA MESA
State : CA
Zip : 92626-7100
Country : US
Telephone Number : 202-455-0013
Fax Number :
Provider Business Practice Location Address
First Line : 500 ALAMITOS AVE STE A
Second Line :
City : LONG BEACH
State : CA
Zip : 90802-1614
Country : US
Telephone Number : 949-304-7031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2021
Last Update Date : 02/01/2021

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