Provider Demographics
NPI:1194601153
Name:GRAY, SARA AYRN (PSS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:AYRN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6876 CAMINITO MONTANOSO UNIT 49
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2333
Mailing Address - Country:US
Mailing Address - Phone:619-767-0280
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY STE 210
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPSSTOJMCS175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist