Healthcare Provider Details

I. General information

NPI: 1013315027
Provider Name (Legal Business Name): EVA BRADLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8581 LAKE BLUFFS CIR
SPRING VALLEY CA
91977-6204
US

IV. Provider business mailing address

8581 LAKE BLUFFS CIR
SPRING VALLEY CA
91977-6204
US

V. Phone/Fax

Practice location:
  • Phone: 619-987-0418
  • Fax:
Mailing address:
  • Phone: 619-987-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038682
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95040403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: