Healthcare Provider Details

I. General information

NPI: 1962108357
Provider Name (Legal Business Name): SONIA GRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 VICTORY BLVD STE 100
NORTH HOLLYWOOD CA
91606-3513
US

IV. Provider business mailing address

11633 VICTORY BLVD STE 100
NORTH HOLLYWOOD CA
91606-3513
US

V. Phone/Fax

Practice location:
  • Phone: 818-833-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax: 833-471-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: