Provider Demographics
NPI:1629071469
Name:CHESLER, BRADLEY HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:HOWARD
Last Name:CHESLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CITRACADO PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4110
Mailing Address - Country:US
Mailing Address - Phone:858-673-9991
Mailing Address - Fax:
Practice Address - Street 1:1955 CITRACADO PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4110
Practice Address - Country:US
Practice Address - Phone:858-673-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43963208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
125649400OtherU.S DEPARTMENT OF LABOR
CA00A439631Medicaid
CA00A439630Medicaid
CA1505013OtherBLUE SHIELD NUMBER
CA330362515920250000OtherTRICARE PROVIDER NUMBER
CA1505013OtherBLUE SHIELD NUMBER