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BENJAMIN BRADLEY PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1548546435
Individual Registrant: BENJAMIN BRADLEY PA-C
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
12586 AVENUE 408 CUTLER/OROSI, CA 93647-9454 US
Tel: 559-528-2804 Fax: 559-528-7623
Tel: 559-528-2804 Fax: 559-528-7623
Contact information for business:
305 EAST CENTER AVE. VISALIA, CA 93291-6331 US
Tel: 559-737-4700 Fax: 559-737-4782
Tel: 559-737-4700 Fax: 559-737-4782
Registration Information:
NPI: 1548546435
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CA | PA21965 |
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CA |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| LICENSE | PA21965 | CA | 01 |
