Provider Demographics
NPI:1568297760
Name:MAC BRAYNE, ZOEY ANN
Entity type:Individual
Prefix:
First Name:ZOEY
Middle Name:ANN
Last Name:MAC BRAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19502 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6133
Mailing Address - Country:US
Mailing Address - Phone:951-205-5111
Mailing Address - Fax:
Practice Address - Street 1:19502 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6133
Practice Address - Country:US
Practice Address - Phone:951-205-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst