Healthcare Provider Details

I. General information

NPI: 1295313211
Provider Name (Legal Business Name): BRADLEY J FRIEDMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11613 W PICO BLVD
LOS ANGELES CA
90064-2908
US

IV. Provider business mailing address

2928 CORRAL CANYON RD
MALIBU CA
90265-2915
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-2288
  • Fax: 310-268-1553
Mailing address:
  • Phone: 310-849-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY J FRIEDMAN
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 310-849-5773