Healthcare Provider Details

I. General information

NPI: 1255622296
Provider Name (Legal Business Name): BRADFORD TINLOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3122
US

IV. Provider business mailing address

2100 POWELL ST STE 900 CEP AMERICA
EMERYVILLE CA
94608-1844
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-3210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52965
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA134822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: