Provider Demographics
NPI:1205546991
Name:DEA, BRADLEY WILLIAM
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:DEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 RIDGESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-3730
Mailing Address - Country:US
Mailing Address - Phone:626-665-3648
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8897
Practice Address - Country:US
Practice Address - Phone:626-457-4254
Practice Address - Fax:626-457-4245
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program