Healthcare Provider Details

I. General information

NPI: 1487587291
Provider Name (Legal Business Name): CHRISTOPHER RYAN GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 E FOOTHILL BLVD STE 234
UPLAND CA
91786-4080
US

IV. Provider business mailing address

1183 E FOOTHILL BLVD STE 234
UPLAND CA
91786-4080
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-0076
  • Fax: 909-931-7777
Mailing address:
  • Phone: 909-949-0076
  • Fax: 909-931-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: