Healthcare Provider Details

I. General information

NPI: 1366726333
Provider Name (Legal Business Name): DINISHA GRAY-MINGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

IV. Provider business mailing address

4000 S EASTERN AVE STE 240
LAS VEGAS NV
89119-0847
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-1400
  • Fax:
Mailing address:
  • Phone: 702-556-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: