Healthcare Provider Details

I. General information

NPI: 1215083795
Provider Name (Legal Business Name): JULIA MOON BRADLEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 INTERNATIONAL BLVD
OAKLAND CA
94606-2235
US

IV. Provider business mailing address

255 INTERNATIONAL BLVD
OAKLAND CA
94606-2235
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-2777
  • Fax: 510-835-0164
Mailing address:
  • Phone: 510-835-2777
  • Fax: 510-835-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRSP2005187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: