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General NPI Number Information
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NPI Number | 1902557226
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Entity Type | Individual
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Provider Name | ALEC BRADBURY
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Gender | Male
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 16 RITTER ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3323
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Country | US
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Telephone | 415-457-8182
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Fax |
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Provider Business Mailing Address
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Address Line | 12710 BROOKPARK RD
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City | OAKLAND
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State | CA
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Zip | 94619-3137
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Country | US
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Telephone | 510-289-0658
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95019763
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License Number State | CA
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