Provider Demographics
NPI:1326583998
Name:RAY, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:RAY
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 1:25460 MEDICAL CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5985
Mailing Address - Country:US
Mailing Address - Phone:951-677-4748
Mailing Address - Fax:951-677-6529
Practice Address - Street 1:25460 MEDICAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5985
Practice Address - Country:US
Practice Address - Phone:951-677-4748
Practice Address - Fax:951-677-6529
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375856363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology