Provider Demographics
NPI:1699434811
Name:BRAY, CINDY ELLEN
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:ELLEN
Last Name:BRAY
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 1:9534 DEEP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8379
Mailing Address - Country:US
Mailing Address - Phone:760-987-4388
Mailing Address - Fax:
Practice Address - Street 1:9534 DEEP CREEK RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-8379
Practice Address - Country:US
Practice Address - Phone:760-987-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21228183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician