Healthcare Provider Details

I. General information

NPI: 1659500080
Provider Name (Legal Business Name): PATRICIA ANN GRAY L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N NEVADA ST
OCEANSIDE CA
92054-2520
US

IV. Provider business mailing address

329 MOONSTONE BAY DR
OCEANSIDE CA
92057-3426
US

V. Phone/Fax

Practice location:
  • Phone: 760-533-3523
  • Fax:
Mailing address:
  • Phone: 760-533-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: