Provider Demographics
NPI:1962622068
Name:BRAY, YOLANDA DELPHINE
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:DELPHINE
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 1:903 W VERNON AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3063
Mailing Address - Country:US
Mailing Address - Phone:323-750-8040
Mailing Address - Fax:323-750-8075
Practice Address - Street 1:2931 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5110
Practice Address - Country:US
Practice Address - Phone:323-750-8040
Practice Address - Fax:323-750-8075
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)