Provider Demographics
NPI:1922619659
Name:BRADLEY, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 ARASTRADERO RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1337
Mailing Address - Country:US
Mailing Address - Phone:800-818-6136
Mailing Address - Fax:
Practice Address - Street 1:1791 ARASTRADERO RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1337
Practice Address - Country:US
Practice Address - Phone:800-818-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-15
Last Update Date:2020-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program