Individual
BODEN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3005 DOUGLAS BLVD STE 105, ROSEVILLE, CA 95661-3885
(916) 742-7718
(510) 350-9190
Mailing address
3005 DOUGLAS BLVD STE 105, ROSEVILLE, CA 95661-3885
(916) 742-7718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
56390
CA
Other
Enumeration date
08/12/2016
Last updated
06/15/2021
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