Provider Demographics
NPI:1033186010
Name:BRADY, WANDA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:ANN
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 W COVINA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3200
Mailing Address - Country:US
Mailing Address - Phone:909-592-9712
Mailing Address - Fax:909-592-7264
Practice Address - Street 1:1330 W COVINA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773
Practice Address - Country:US
Practice Address - Phone:909-592-9712
Practice Address - Fax:909-592-7264
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA62753AMedicaid
H04804Medicare UPIN