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General NPI Number Information
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NPI Number | 1851817233
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Entity Type | Individual
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Provider Name | ANTHONY CHARLES BRADLEY HIS
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Gender | Male
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 1600 E FLORIDA AVE STE 312&314
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City | HEMET
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State | CA
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Zip | 92544-8643
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Country | US
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Telephone | 951-652-9143
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Fax | 951-929-6653
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Provider Business Mailing Address
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Address Line | 528 N PALM AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3218
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Country | US
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Telephone | 909-986-9635
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Fax | 909-391-5873
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State | CA
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