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General NPI Number Information
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NPI Number | 1124268479
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Entity Type | Individual
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Provider Name | JULIE K. GRAY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD 906
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City | LOS ANGELES
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State | CA
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Zip | 90004-3025
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Country | US
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Telephone | 323-464-8046
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Fax | 323-464-1832
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Provider Business Mailing Address
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Address Line | 321 N LARCHMONT BLVD 906
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City | LOS ANGELES
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State | CA
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Zip | 90004-3025
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Country | US
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Telephone | 323-464-8046
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Fax | 323-464-1832
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 17940
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License Number State | CA
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