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General NPI Number Information
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NPI Number | 1992830616
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Entity Type | Organization
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Legal Business Name | BRADLEY MEDICAL PRODUCTS INC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 20101 SW BIRCH ST 150 P
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1748
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Country | US
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Telephone | 949-222-2206
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Fax | 949-644-0070
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | NEWPORT BEACH
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State | CA
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Zip | 92662-0008
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Country | US
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Telephone | 949-222-2206
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Fax | 949-644-0070
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Authorized Official
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Title or Position | OWNER
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Name | MR. KYLE BRADLEY ANDERSON
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Credential |
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Telephone | 949-378-7787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 44257
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License Number State | CA
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