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NPI Code Detail

MEDICARE: VINCENT ERIC BRADFORD

MEDICARE: VINCENT ERIC BRADFORD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1477896546
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT ERIC BRADFORD
Provider Business Mailing Address
First Line : 3501 SHADY TIMBER ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7586
Country : US
Telephone Number : 702-350-1763
Fax Number :
Provider Business Practice Location Address
First Line : 6889 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4687
Country : US
Telephone Number : 702-434-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2013
Last Update Date : 04/21/2015

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Directions to “ VINCENT ERIC BRADFORD ” Practice Location

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