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General NPI Number Information
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NPI Number | 1871777664
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Entity Type | Organization
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Legal Business Name | TONDA D BRADSHAW D O A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 35237 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-4340
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Country | US
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Telephone | 909-790-6200
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Fax | 909-790-6220
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Provider Business Mailing Address
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Address Line | 35237 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-4340
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Country | US
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Telephone | 909-790-6200
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Fax | 909-790-6220
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONDA D BRADSHAW
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Credential | D.O.
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Telephone | 909-790-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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