Healthcare Provider Details

I. General information

NPI: 1790422913
Provider Name (Legal Business Name): BRADLY JOEL BRENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 KNOTTS ST
BAKERSFIELD CA
93305-3043
US

IV. Provider business mailing address

5121 STOCKDALE HWY
BAKERSFIELD CA
93309-2656
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-1817
  • Fax: 661-325-3929
Mailing address:
  • Phone: 661-868-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: