MEDICARE: DR. ROBERT L BRAY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS 10054	CA

General Provider Information

NPI Number	:	1154491363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L BRAY PHD

Provider Business Mailing Address
First Line	:	5959 MISSION GORGE RD
Second Line	:	SUITE 106
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4017
Country	:	US
Telephone Number	:	619-283-1116
Fax Number	:	619-283-1131

Provider Business Practice Location Address
First Line	:	5959 MISSION GORGE RD
Second Line	:	SUITE 106
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4017
Country	:	US
Telephone Number	:	619-283-1116
Fax Number	:	619-283-1131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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