MEDICARE: ELIZABETH BRADFORD CNM

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	367A00000X	Advanced Practice Midwife	CNM10343	CA

General Provider Information

NPI Number	:	1942189915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BRADFORD CNM

Provider Business Mailing Address
First Line	:	7430 CABRILLO AVE
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-5201
Country	:	US
Telephone Number	:	979-676-6750
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 CAMINO DEL RIO S STE 109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4007
Country	:	US
Telephone Number	:	979-676-6750
Fax Number	:

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

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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