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General NPI Number Information
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NPI Number | 1053864876
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Entity Type | Individual
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Provider Name | LORI RAY M.ED., ATC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1313 PARK BLVD SAN DIEGO CITY COLLEGE
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City | SAN DIEGO
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State | CA
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Zip | 92101
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Country | US
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Telephone | 619-388-3750
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Fax | 619-388-3651
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Provider Business Mailing Address
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Address Line | 4046 ARIZONA ST APT 4
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City | SAN DIEGO
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State | CA
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Zip | 92104-1778
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Country | US
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Telephone | 619-388-3750
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Fax | 619-388-3651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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