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General NPI Number Information
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NPI Number | 1851662258
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Entity Type | Individual
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Provider Name | LUZ MARINA BRADBERRY NP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 1914 E. JUAN SANCHEZ BLVD #2
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City | SAN LUIS
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State | AZ
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Zip | 85349-7101
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Country | US
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Telephone | 928-283-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 E EBONY DR
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City | CHANDLER
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State | AZ
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Zip | 85286-2762
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Country | US
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Telephone | 949-929-6613
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP5240
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License Number State | AZ
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