Healthcare Provider Details

I. General information

NPI: 1215578224
Provider Name (Legal Business Name): VALERIE JEAN GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S HOLLY AVE
COMPTON CA
90221-4107
US

IV. Provider business mailing address

807 S HOLLY AVE
COMPTON CA
90221-4107
US

V. Phone/Fax

Practice location:
  • Phone: 562-253-5139
  • Fax:
Mailing address:
  • Phone: 562-253-5139
  • Fax: 562-826-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: