Healthcare Provider Details

I. General information

NPI: 1528982840
Provider Name (Legal Business Name): DEBORAH MARIE BRAY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 GEARY BLVD STE 100
SAN FRANCISCO CA
94118-3044
US

IV. Provider business mailing address

863 ROCKAWAY BEACH AVE
PACIFICA CA
94044-3234
US

V. Phone/Fax

Practice location:
  • Phone: 415-895-9832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: