Healthcare Provider Details

I. General information

NPI: 1841772647
Provider Name (Legal Business Name): GWENDOLYN N/A BRADFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125B
OAKLAND CA
94605-2456
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125B
OAKLAND CA
94605-2456
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-4246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: