Individual
BRADLEY A JABOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2811 WILSHIRE BLVD STE 810, SANTA MONICA, CA 90403-4812
(310) 829-9788
(310) 453-1576
Mailing address
2811 WILSHIRE BLVD STE 810, SANTA MONICA, CA 90403-4812
(310) 829-9788
(310) 453-1576
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
A41876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A418760
BLUE SHIELD OF CA
CA
05
—
00A418760
—
CA
Enumeration date
04/02/2007
Last updated
07/08/2007
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