Provider Demographics
NPI:1417209750
Name:BRADFORD, ROCHELLE ANN
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 ASPENBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5400
Mailing Address - Country:US
Mailing Address - Phone:702-588-9961
Mailing Address - Fax:
Practice Address - Street 1:8312 ASPENBROOK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5400
Practice Address - Country:US
Practice Address - Phone:702-588-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor