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General NPI Number Information
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NPI Number | 1831473198
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Entity Type | Individual
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Provider Name | CALI J BRADBERRY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 4750 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-2715
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Country | US
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Telephone | 208-375-0500
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Fax | 208-375-4310
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Provider Business Mailing Address
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Address Line | 5985 W STATE ST
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City | BOISE
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State | ID
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Zip | 83703-3039
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Country | US
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Telephone | 208-853-0071
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Fax | 208-853-9422
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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 | PA-937
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-937
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-937
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License Number State | ID
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