Basic Information
| Provider Information | |||||||||
| NPI: | 1215083795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | MOON | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 INTERNATIONAL BLVD | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946062235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108352777 | ||||||||
| FaxNumber: | 5108350164 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 INTERNATIONAL BLVD | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946062235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108352777 | ||||||||
| FaxNumber: | 5108350164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 09/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RSP2005187 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.