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General NPI Number Information
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NPI Number | 1235560731
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Entity Type | Individual
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Provider Name | BRADLEY LEIGHTON ALLSMAN
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Gender | Male
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 1300 S GRAND AVE BLDG C213-W
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City | SANTA ANA
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State | CA
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Zip | 92705-4434
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Country | US
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Telephone | 562-665-0325
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Fax |
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Provider Business Mailing Address
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Address Line | 14660 OXNARD ST
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City | VAN NUYS
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State | CA
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Zip | 91411-3119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW95461
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License Number State | CA
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