Provider Demographics
NPI:1598824419
Name:BRADFORD, VIVIAN ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 S. BEMIS ST.
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-3649
Mailing Address - Country:US
Mailing Address - Phone:303-798-1173
Mailing Address - Fax:
Practice Address - Street 1:200 W. COUNTY LINE RD.
Practice Address - Street 2:SUITE 130
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-791-0418
Practice Address - Fax:303-791-9113
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
454548Medicare UPIN