Individual
SUSAN GENEVIEVE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3186 AIRWAY AVE, COSTA MESA, CA 92626-4650
(469) 938-9987
Mailing address
6751 ATLANTIC AVE, LONG BEACH, CA 90805-1411
(469) 938-9987
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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