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NPI Code Detail

MEDICARE: GWENDOLYN N/A BRADFORD

MEDICARE: GWENDOLYN N/A BRADFORD
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
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1841772647
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN N/A BRADFORD
Provider Business Mailing Address
First Line : 7200 BANCROFT AVE STE 125B
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2456
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7200 BANCROFT AVE STE 125B
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2456
Country : US
Telephone Number : 510-777-4246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 08/29/2018

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Directions to “ GWENDOLYN N/A BRADFORD ” Practice Location

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