MEDICARE: BRIDGET CORDRAY PA-C

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
1	363A00000X	Physician Assistant	54376	CA

General Provider Information

NPI Number	:	1730614298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET CORDRAY PA-C

Provider Business Mailing Address
First Line	:	447 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-468-2905
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-468-2905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	06/22/2022

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Directions to “ BRIDGET CORDRAY PA-C” Practice Location

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