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NPI Code Detail

MEDICARE: MR. JAMES RICHARD BRAY

MEDICARE: MR. JAMES RICHARD BRAY
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1770730269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES RICHARD BRAY
Provider Business Mailing Address
First Line : 1623 S DODSON AVE
Second Line :
City : SAN PEDRO
State : CA
Zip : 90732-4025
Country : US
Telephone Number : 310-514-9241
Fax Number :
Provider Business Practice Location Address
First Line : 2330 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2220
Country : US
Telephone Number : 213-342-3114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2008
Last Update Date : 08/26/2008

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