Provider Demographics
NPI:1700259181
Name:BRADBURY, ELIZABETH ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALEXANDRA
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9670
Mailing Address - Country:US
Mailing Address - Phone:831-234-6588
Mailing Address - Fax:
Practice Address - Street 1:150 CARNATION DR
Practice Address - Street 2:STE. 2
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3132
Practice Address - Country:US
Practice Address - Phone:831-722-8123
Practice Address - Fax:831-722-8486
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53014363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical