Healthcare Provider Details

I. General information

NPI: 1669838892
Provider Name (Legal Business Name): MAUREEN BRADLEY RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7643 PAINTER AVE
WHITTIER CA
90602-2358
US

IV. Provider business mailing address

9327 LEXINGTON ST
CYPRESS CA
90630-2729
US

V. Phone/Fax

Practice location:
  • Phone: 917-373-5571
  • Fax: 562-693-4525
Mailing address:
  • Phone: 562-464-5380
  • Fax: 562-693-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number802944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: