Healthcare Provider Details

I. General information

NPI: 1619829702
Provider Name (Legal Business Name): QIANA GRAY NP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N SAN JACINTO ST
HEMET CA
92543-3124
US

IV. Provider business mailing address

1015 ARMORLITE DR APT 232
SAN MARCOS CA
92069-1698
US

V. Phone/Fax

Practice location:
  • Phone: 951-665-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: