NPI 1083306948

Susan Genevieve Gray

Practitioner Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Costa Mesa, CA

Practice location

Address: 3186 Airway Ave, Costa Mesa, CA 92626-4650
Phone: (469) 938-9987
Mailing address: 6751 Atlantic Ave, Long Beach, CA 90805-1411

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in California →

Registry record

NPI: 1083306948
Entity type: Individual
Sex (as registered): Female
NPI issued: 22 May 2023
Record last updated: 22 May 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.