Provider Demographics
NPI:1366729394
Name:GRAY, PAULA YVETTE (LICENSE VOCATIONAL N)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:YVETTE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LICENSE VOCATIONAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 WEST 65TH PLACE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4235
Mailing Address - Country:US
Mailing Address - Phone:310-425-6612
Mailing Address - Fax:
Practice Address - Street 1:1733 WEST 65TH PLACE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4235
Practice Address - Country:US
Practice Address - Phone:310-425-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN188082164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse