Healthcare Provider Details

I. General information

NPI: 1467366807
Provider Name (Legal Business Name): STACIA ANN BRADFIELD MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MOBIL AVE STE D9
CAMARILLO CA
93010-6376
US

IV. Provider business mailing address

5394 FELICIA ST
CAMARILLO CA
93012-7312
US

V. Phone/Fax

Practice location:
  • Phone: 805-738-5700
  • Fax:
Mailing address:
  • Phone: 805-824-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: