Healthcare Provider Details

I. General information

NPI: 1770315178
Provider Name (Legal Business Name): ZACHARY GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SAINT ROSE PKWY STE 200
HENDERSON NV
89052-4841
US

IV. Provider business mailing address

2831 SAINT ROSE PKWY STE 200
HENDERSON NV
89052-4841
US

V. Phone/Fax

Practice location:
  • Phone: 725-202-1022
  • Fax:
Mailing address:
  • Phone: 725-202-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: