Individual
INDIRA GREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4941 OLIVEHURST AVE, OLIVEHURST, CA 95961-4225
(530) 743-4611
(530) 743-4614
Mailing address
PO BOX A D, YUBA CITY, CA 95992-1396
(530) 751-3769
(530) 751-1237
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17723
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA17723
LICENSE
CA
Enumeration date
07/19/2006
Last updated
12/19/2011
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