Provider Demographics
NPI:1215424411
Name:GRAY, ESPERANZA G
Entity type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:G
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18370 BURBANK BL SUITE 204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2890
Mailing Address - Country:US
Mailing Address - Phone:818-345-0932
Mailing Address - Fax:818-345-9052
Practice Address - Street 1:18370 BURBANK BL SUITE 204
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2890
Practice Address - Country:US
Practice Address - Phone:818-345-0932
Practice Address - Fax:818-345-9052
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218442163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty