Healthcare Provider Details

I. General information

NPI: 1851116586
Provider Name (Legal Business Name): CHANBRAY GAITHER RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANBRAY WILLIAMS

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 S MANCHESTER AVE
ANAHEIM CA
92802-2905
US

IV. Provider business mailing address

2475 MOON DUST DR
CHINO HILLS CA
91709-4330
US

V. Phone/Fax

Practice location:
  • Phone: 714-782-1700
  • Fax:
Mailing address:
  • Phone: 909-521-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95190928
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: