Provider Demographics
NPI:1427417922
Name:WASHINGTON, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 VERNON ST
Mailing Address - Street 2:NO. 104
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3064
Mailing Address - Country:US
Mailing Address - Phone:510-338-8966
Mailing Address - Fax:
Practice Address - Street 1:544 INTERNATIONAL BLVD
Practice Address - Street 2:#9
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2973
Practice Address - Country:US
Practice Address - Phone:510-444-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker