Individual
BENJAMIN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12586 AVENUE 408, CUTLER/OROSI, CA 93647-9454
(559) 528-2804
(559) 528-7623
Mailing address
305 EAST CENTER AVE., VISALIA, CA 93291-6331
(559) 737-4700
(559) 737-4782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA21965
CA
363A00000X
Physician Assistant
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA21965
LICENSE
CA
Enumeration date
10/24/2011
Last updated
12/21/2011
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