Healthcare Provider Details

I. General information

NPI: 1528018470
Provider Name (Legal Business Name): BRADLEY T. ANDERSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

IV. Provider business mailing address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5615
  • Fax: 951-697-5687
Mailing address:
  • Phone: 951-697-5615
  • Fax: 951-697-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA89184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: