Individual
BRADFORD LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24012 CALLE DE LA PLATA STE 150, LAGUNA HILLS, CA 92653-3632
(949) 588-7246
Mailing address
24012 CALLE DE LA PLATA STE 150, LAGUNA HILLS, CA 92653-3632
(949) 588-7246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
08/04/2026
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