Provider Demographics
NPI:1326099151
Name:HINER, BRADLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:C
Last Name:HINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE STE 470
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7659
Mailing Address - Country:US
Mailing Address - Phone:805-988-2775
Mailing Address - Fax:805-278-1220
Practice Address - Street 1:1700 N ROSE AVE STE 470
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7659
Practice Address - Country:US
Practice Address - Phone:805-988-2775
Practice Address - Fax:805-278-1220
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI289722084N0400X
CAG522612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326099151Medicaid
007806261HOtherHUMANA
B53613Medicare UPIN
007806261HOtherHUMANA