Healthcare Provider Details

I. General information

NPI: 1912786401
Provider Name (Legal Business Name): JOSEPH ROSS BRADLEY PMHNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST
SALINAS CA
93901-3400
US

IV. Provider business mailing address

232 OAK ST
SALINAS CA
93901-4130
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-7530
  • Fax:
Mailing address:
  • Phone: 605-484-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: