Healthcare Provider Details

I. General information

NPI: 1588775480
Provider Name (Legal Business Name): BRADLEY JAY AGUIRRE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 VERDUGO BLVD SUITE 303
GLENDALE CA
91208-9976
US

IV. Provider business mailing address

1818 VERDUGO BLVD SUITE 303
GLENDALE CA
91208-9976
US

V. Phone/Fax

Practice location:
  • Phone: 818-248-2454
  • Fax: 818-248-8503
Mailing address:
  • Phone: 818-952-2600
  • Fax: 818-952-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: