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General NPI Number Information
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NPI Number | 1821748310
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Entity Type | Individual
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Provider Name | BRADLEY JOHN NEDDENRIEP MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2022
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 525 N GARFIELD AVE
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1202
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Country | US
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Telephone | 818-839-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1366 BRENTWOOD CIR UNIT C
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City | CORONA
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State | CA
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Zip | 92882-7053
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Country | US
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Telephone | 775-267-7223
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A191573
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License Number State | CA
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