Provider Demographics
NPI:1669643045
Name:BRADFORD, PAUL MARTIN (RRW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MARTIN
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W LANCASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2305
Mailing Address - Country:US
Mailing Address - Phone:661-726-2630
Mailing Address - Fax:661-951-8820
Practice Address - Street 1:907 W LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2305
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-951-8820
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW0234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)