Active NPI
Jennifer M Gray
- Behavior Technician
- Concord, CA
National Provider Identifier
1225714751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1200 Concord Ave Ste 100
Concord, CA 94520-4969 - Phone
- (510) 268-8120
- NPI assigned
- Jun 27, 2023
- Reactivated
- Jul 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 0000000000 | CA | |
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Mailing address
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Phone (510) 268-8120
Other practice location 1
24011 Cormorant Ln
Laguna Niguel, CA 92677-1392
Phone (949) 306-1108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000000000 | CA | MD | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1225714751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 100",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204969",
"telephone_number": "510-268-8120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 100",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204969",
"telephone_number": "510-268-8120"
}
],
"practiceLocations": [
{
"address_1": "24011 Cormorant Ln",
"address_purpose": "LOCATION",
"city": "Laguna Niguel",
"state": "CA",
"postal_code": "926771392",
"country_code": "US",
"telephone_number": "949-306-1108",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAY",
"first_name": "JENNIFER",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-27",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"deactivation_date": "2023-06-28",
"reactivation_date": "2023-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "0000000000",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.