Healthcare Provider Details

I. General information

NPI: 1790296598
Provider Name (Legal Business Name): HALEY BRAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9665 CAMPO RD
SPRING VALLEY CA
91977-1228
US

IV. Provider business mailing address

4979 DUBOIS DR
SAN DIEGO CA
92117-1920
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-4051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: