Individual
ANTA L BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.V.N.
Contact information
Practice address
11417 BRIGHT STAR TRL, MORENO VALLEY, CA 92557-5617
(951) 490-5943
Mailing address
11417 BRIGHT STAR TRL, MORENO VALLEY, CA 92557-5617
(951) 490-5943
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
180873
CA
Other
Enumeration date
08/20/2012
Last updated
08/20/2012
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