Provider Demographics
NPI:1952957383
Name:BRADFORD, MARGARITA
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-040 KAUHALE STREET
Mailing Address - Street 2:#1961
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-9998
Mailing Address - Country:US
Mailing Address - Phone:334-625-0706
Mailing Address - Fax:
Practice Address - Street 1:99-040 KAUHALE STREET
Practice Address - Street 2:#1961
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-9998
Practice Address - Country:US
Practice Address - Phone:334-625-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist