Individual
LAURA BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 4TH AVE, SUITE 307, CHULA VISTA, CA 91910-4410
(619) 426-3240
(619) 426-5964
Mailing address
480 4TH AVE, SUITE 307, CHULA VISTA, CA 91910-4403
(619) 426-3240
(619) 426-5964
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
53585
CA
363AS0400X
Surgical Physician Assistant
53585
CA
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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