Provider Demographics
NPI:1023139797
Name:LUZ, BRADFORD RAYMOND
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:RAYMOND
Last Name:LUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRADFORD
Other - Middle Name:RAYMOND
Other - Last Name:LUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1415 OWL PT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4395
Mailing Address - Country:US
Mailing Address - Phone:707-537-7837
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC RD
Practice Address - Street 2:SUITE #4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2218
Practice Address - Country:US
Practice Address - Phone:530-891-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10361103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist