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General NPI Number Information
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NPI Number | 1669040879
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Entity Type | Individual
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Provider Name | JESSICA GRAY L.AC. DAC, MSAC
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 19820 N 7TH ST STE 135
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City | PHOENIX
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State | AZ
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Zip | 85024-1698
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Country | US
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Telephone | 480-744-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 19820 N 7TH ST STE 135
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City | PHOENIX
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State | AZ
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Zip | 85024-1698
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | LAC-010748
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License Number State | AZ
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