Healthcare Provider Details

I. General information

NPI: 1154352011
Provider Name (Legal Business Name): DUANE E BRIDGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 HAWTHORNE BLVD #400
HAWTHORNE CA
90250-2321
US

IV. Provider business mailing address

11633 HAWTHORNE BLVD #400
HAWTHORNE CA
90250-2321
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-0600
  • Fax: 310-419-0834
Mailing address:
  • Phone: 310-973-0600
  • Fax: 310-419-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG63954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG63954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: