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General NPI Number Information
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NPI Number | 1194601153
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Entity Type | Individual
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Provider Name | SARA AYRN GRAY PSS
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Gender | Female
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1000 BROADWAY STE 210
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City | EL CAJON
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State | CA
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Zip | 92021-4899
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Country | US
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Telephone | 619-401-5541
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Fax |
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Provider Business Mailing Address
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Address Line | 6876 CAMINITO MONTANOSO UNIT 49
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City | SAN DIEGO
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State | CA
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Zip | 92119-2333
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Country | US
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Telephone | 619-767-0280
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSSTOJMCS
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License Number State |
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