Provider Demographics
NPI:1801044078
Name:BRAY PLASTIC SURGERY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BRAY PLASTIC SURGERY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-534-8300
Mailing Address - Street 1:23560 MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4709
Mailing Address - Country:US
Mailing Address - Phone:310-534-8300
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:5 HOLLAND STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2568
Practice Address - Country:US
Practice Address - Phone:949-588-2199
Practice Address - Fax:949-588-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP35839261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP35839OtherSTATE OF CALIFORNIA LICENSE