Healthcare Provider Details

I. General information

NPI: 1760576839
Provider Name (Legal Business Name): BRADLEY OGDEN HUDSON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD SUITES 320, 500 & 600
LOS ANGELES CA
90010-1577
US

IV. Provider business mailing address

3250 WILSHIRE BLVD SUITE 320, 500 & 600
LOS ANGELES CA
90010-1577
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3814
  • Fax: 323-361-8350
Mailing address:
  • Phone: 323-361-3814
  • Fax: 323-361-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY13124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: