Provider Demographics
NPI:1285951160
Name:GRAY, ALICIA CHRISTINA (MS)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:CHRISTINA
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:GRAY
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:MOB 7/ PSYCHIATRY OFFICE
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5711
Mailing Address - Country:US
Mailing Address - Phone:866-205-3595
Mailing Address - Fax:
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:866-205-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist