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General NPI Number Information
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NPI Number | 1700159639
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Entity Type | Individual
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Provider Name | BRADLEY GAIL COPPESS CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 700 LAWRENCE EXPY
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City | SANTA CLARA
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State | CA
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Zip | 95051-5173
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Country | US
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Telephone | 408-851-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 401 MOANA WAY
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City | PACIFICA
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State | CA
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Zip | 94044-2837
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Country | US
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Telephone | 585-967-8819
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4187
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License Number State | OH
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