MEDICARE: BRIDGET KATHLEEN CLEARY PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95000382	CA

General Provider Information

NPI Number	:	1053691790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET KATHLEEN CLEARY PMHNP-BC

Provider Business Mailing Address
First Line	:	12215 TELEGRAPH RD STE 107
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Provider Business Practice Location Address
First Line	:	12215 TELEGRAPH RD STE 107
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	04/11/2024

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