Provider Demographics
NPI:1578584223
Name:BRADLEY, MARIA ELIZABETH BELOY (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA ELIZABETH
Middle Name:BELOY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA ELIZABETH
Other - Middle Name:BELOY
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, MPAS, MPH, MD,
Mailing Address - Street 1:600 HOSKING AVE APT 37D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5731
Mailing Address - Country:US
Mailing Address - Phone:509-594-1135
Mailing Address - Fax:
Practice Address - Street 1:9001 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5948
Practice Address - Country:US
Practice Address - Phone:661-328-4260
Practice Address - Fax:661-617-2881
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60030912363A00000X
CAPA17041363A00000X
UT354518-1206363A00000X
UT354518-8906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17041OtherPAC-CALIFORNIA PA LICENSE
UTQ71124Medicare UPIN