Indira Grey, PA
Individual provider Active NPI Medical Physician Assistant · Olivehurst, CA
NPI 1407875487 · NPPES record last updated Dec 19, 2011
Key facts
- NPI
- 1407875487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA17723 (CA)
- Practice address
- 4941 Olivehurst Ave
Olivehurst, CA 95961-4225 - Phone
- (530) 743-4611
- Fax
- (530) 743-4614
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA17723 | CA | Yes |
Addresses
Primary practice location
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Mailing address
PO Box a D
Yuba City, CA 95992-1396
Phone (530) 751-3769
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA17723 | Other | CA | LICENSE |
Other providers in Olivehurst, CA
- Annette Gallardo
- Victoria Aiko Garibay
- Gursharon Kaur Gill
- Joanna Gomez
- America Gorman
- Cheyenne Kay Hall
- Hyesung Han
- Houa Patti Her
- Jaqueline Hernandez Flores
- Tara Kay Hernandez
All providers in Olivehurst, CA · Medical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.