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General NPI Number Information
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NPI Number | 1366588261
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Entity Type | Individual
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Provider Name | BRADLEY J ENGWALL MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 2020 MILVIA ST STE 450
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City | BERKELEY
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State | CA
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Zip | 94704-2685
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Country | US
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Telephone | 510-559-1819
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Fax | 510-559-1819
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Provider Business Mailing Address
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Address Line | 2020 MILVIA ST STE 450
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City | BERKELEY
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State | CA
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Zip | 94704-2685
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Country | US
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Telephone | 510-559-1819
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Fax | 510-559-1819
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A62477
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A62477
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License Number State | CA
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