Healthcare Provider Details

I. General information

NPI: 1790728277
Provider Name (Legal Business Name): BRADLEY K. GERBERICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD EMERGENCY DEPARTMENT
PASADENA CA
91105-3010
US

IV. Provider business mailing address

100 W. CALIFORNIA BLVD. EMERGENCY DEPARTMENT
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 818-585-9562
  • Fax: 818-706-1680
Mailing address:
  • Phone: 818-585-9526
  • Fax: 818-706-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG61036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: