Healthcare Provider Details

I. General information

NPI: 1992724785
Provider Name (Legal Business Name): BRADLEY C POWERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 105
GLENDALE CA
91205-4432
US

IV. Provider business mailing address

8237 RAVENDALE RD
SAN GABRIEL CA
91775-1041
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2200
  • Fax: 818-265-2201
Mailing address:
  • Phone: 626-292-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63910
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA63910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: