Healthcare Provider Details

I. General information

NPI: 1033935382
Provider Name (Legal Business Name): EMILY RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 25TH ST
SAN DIEGO CA
92102-2107
US

IV. Provider business mailing address

15823 THE RIVER TRAIL
DEL MAR CA
92067
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-0067
  • Fax: 619-233-3990
Mailing address:
  • Phone: 213-703-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: