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General NPI Number Information
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NPI Number | 1316619398
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Entity Type | Individual
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Provider Name | GABRIEL EZRA BRADLEY CNM, WHNP
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Gender |
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 4555 PRECISSI LN
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City | STOCKTON
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State | CA
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Zip | 95207-5743
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Country | US
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Telephone | 818-333-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 765 RAND AVE APT 306
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City | OAKLAND
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State | CA
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Zip | 94610-2210
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Country | US
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Telephone | 818-333-6424
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95031422
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State | CA
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