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General NPI Number Information
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NPI Number | 1932903622
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Entity Type | Individual
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Provider Name | COURTNEY RAY
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Gender |
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 10333 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-5808
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Country | US
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Telephone | 805-468-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 333 WASHINGTON BLVD # 343
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5152
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Country | US
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Telephone | 916-224-1735
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032864
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License Number State | CA
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