Healthcare Provider Details

I. General information

NPI: 1205489408
Provider Name (Legal Business Name): WHITNEY OLIVIA GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 05/23/2022
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD STE 200
OXNARD CA
93036-8210
US

IV. Provider business mailing address

301 N R ST
LOMPOC CA
93436-5226
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 303-641-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95098980
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: