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NPI Code Detail

MEDICARE: SIDNEY BRAGDON AMFT

MEDICARE: SIDNEY BRAGDON AMFT
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
1106H00000XMarriage & Family Therapist132270CA

General Provider Information

NPI Number : 1902373798
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY BRAGDON AMFT
Provider Business Mailing Address
First Line : 151 E CANAL DR
Second Line :
City : TURLOCK
State : CA
Zip : 95380-3901
Country : US
Telephone Number : 209-669-2577
Fax Number :
Provider Business Practice Location Address
First Line : 2513 YOUNGSTOWN RD
Second Line :
City : TURLOCK
State : CA
Zip : 95380-9707
Country : US
Telephone Number : 209-669-2577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2018
Last Update Date : 08/10/2022

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Directions to “ SIDNEY BRAGDON AMFT” Practice Location

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