Healthcare Provider Details

I. General information

NPI: 1124978358
Provider Name (Legal Business Name): RACHEL GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR STE 101
BEVERLY HILLS CA
90210-4209
US

IV. Provider business mailing address

8306 WILSHIRE BLVD # 578
BEVERLY HILLS CA
90211-2304
US

V. Phone/Fax

Practice location:
  • Phone: 818-635-8373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: