Healthcare Provider Details

I. General information

NPI: 1760020432
Provider Name (Legal Business Name): ANGUS MATTHEW GRAY LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SOLEDAD DR
MONTEREY CA
93940-6037
US

IV. Provider business mailing address

75 SOLEDAD DR
MONTEREY CA
93940-6037
US

V. Phone/Fax

Practice location:
  • Phone: 510-420-3844
  • Fax:
Mailing address:
  • Phone: 510-420-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: