Provider Demographics
NPI:1669748711
Name:BRADLEY/CABRERA ENTERPRISES
Entity type:Organization
Organization Name:BRADLEY/CABRERA ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-385-4464
Mailing Address - Street 1:25420 HIGHWAY 1
Mailing Address - Street 2:SUITE E
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-7513
Mailing Address - Country:US
Mailing Address - Phone:225-385-4464
Mailing Address - Fax:225-385-4465
Practice Address - Street 1:25420 HIGHWAY 1
Practice Address - Street 2:SUITE E
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-7513
Practice Address - Country:US
Practice Address - Phone:225-385-4464
Practice Address - Fax:225-385-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization