Provider Demographics
NPI:1831363910
Name:ROELOFS, BRAD (CCT)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:
Last Name:ROELOFS
Suffix:
Gender:M
Credentials:CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 CROWN VALLEY PKWY # D4-149
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27702 CROWN VALLEY PKWY
Practice Address - Street 2:D4149
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0608
Practice Address - Country:US
Practice Address - Phone:949-407-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ42363ZOtherBLUE SHIELD ITS
CAZZZ42363ZOtherBLUE SHIELD ITS