Individual
BRADLEY RUSSELL SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1260 15TH ST STE 1024, SANTA MONICA, CA 90404-1145
(424) 259-8570
(424) 259-6180
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
A194680
CA
Other
Enumeration date
05/05/2020
Last updated
10/30/2024
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