Provider Demographics
NPI:1851817233
Name:BRADLEY, ANTHONY CHARLES (HIS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHARLES
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3218
Mailing Address - Country:US
Mailing Address - Phone:909-986-9635
Mailing Address - Fax:909-391-5873
Practice Address - Street 1:1600 E FLORIDA AVE STE 312&314
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8643
Practice Address - Country:US
Practice Address - Phone:951-652-9143
Practice Address - Fax:951-929-6653
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist