Provider Demographics
NPI:1316466501
Name:GRAY, KHRYSTAL ANN
Entity type:Individual
Prefix:
First Name:KHRYSTAL
Middle Name:ANN
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 1:233 S QUINTANA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4029
Mailing Address - Country:US
Mailing Address - Phone:714-988-9822
Mailing Address - Fax:
Practice Address - Street 1:233 S QUINTANA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4029
Practice Address - Country:US
Practice Address - Phone:714-988-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician