Provider Demographics
NPI:1326534363
Name:RADFORD, TRACIE (TRICHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:
Last Name:RADFORD
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2227
Mailing Address - Country:US
Mailing Address - Phone:951-686-2921
Mailing Address - Fax:
Practice Address - Street 1:6086 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2227
Practice Address - Country:US
Practice Address - Phone:951-686-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist