Healthcare Provider Details

I. General information

NPI: 1104482389
Provider Name (Legal Business Name): BRADLEY SEAN NEUTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25381 COMMERCENTRE DR
LAKE FOREST CA
92630-8860
US

IV. Provider business mailing address

25381 COMMERCENTRE DR
LAKE FOREST CA
92630-8860
US

V. Phone/Fax

Practice location:
  • Phone: 949-881-5683
  • Fax: 949-810-8417
Mailing address:
  • Phone: 949-881-5683
  • Fax: 949-810-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA177496
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA177496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: