Healthcare Provider Details

I. General information

NPI: 1700711140
Provider Name (Legal Business Name): SN' GRAY SAVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21221 S WESTERN AVE STE 1024
TORRANCE CA
90501-2970
US

IV. Provider business mailing address

21221 S WESTERN AVE STE 1024
TORRANCE CA
90501-2970
US

V. Phone/Fax

Practice location:
  • Phone: 310-331-2902
  • Fax: 888-414-7839
Mailing address:
  • Phone: 310-331-2902
  • Fax: 888-414-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SHELLYDALE P GRAY
Title or Position: CEO/ADMINISTRATOR
Credential: ADMINISTRATION
Phone: 310-331-2902