Provider Demographics
NPI:1598929291
Name:BRADLEY, CHRISTA LEIGH POWELL (MPH, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:LEIGH POWELL
Last Name:BRADLEY
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Gender:F
Credentials:MPH, PA-C
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Mailing Address - Street 1:1871 MARTIN AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2501
Mailing Address - Country:US
Mailing Address - Phone:408-988-8581
Mailing Address - Fax:408-988-8734
Practice Address - Street 1:1871 MARTIN AVE
Practice Address - Street 2:STE. 102
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2501
Practice Address - Country:US
Practice Address - Phone:408-988-8581
Practice Address - Fax:408-988-8734
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant