Healthcare Provider Details

I. General information

NPI: 1316619398
Provider Name (Legal Business Name): GABRIEL EZRA BRADLEY CNM, WHNP
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ALANA GABRIELLE BRADLEY

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 PRECISSI LN
STOCKTON CA
95207-5743
US

IV. Provider business mailing address

765 RAND AVE APT 306
OAKLAND CA
94610-2210
US

V. Phone/Fax

Practice location:
  • Phone: 818-333-6424
  • Fax:
Mailing address:
  • Phone: 818-333-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95031422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: