| Tonda D Bradshaw D O A Professional Corporation | |
|
35237 Yucaipa Blvd Yucaipa CA 92399-4340 | |
| (909) 790-6200 | |
| (909) 790-6220 |
| Full Name | Tonda D Bradshaw D O A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 35237 Yucaipa Blvd, Yucaipa, California |
| Authorized Official Name and Position | Tonda D Bradshaw (PRESIDENT) |
| Authorized Official Contact | 9097906200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tonda D Bradshaw D O A Professional Corporation 35237 Yucaipa Blvd Yucaipa CA 92399-4340 Ph: (909) 790-6200 | Tonda D Bradshaw D O A Professional Corporation 35237 Yucaipa Blvd Yucaipa CA 92399-4340 Ph: (909) 790-6200 |
| NPI Number | 1871777664 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 02/22/2019 |
| Medicare PECOS PAC ID | 9436062270 |
|---|---|
| Medicare Enrollment ID | O20031107000674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871777664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tonda Bradshaw |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760574123 PECOS PAC ID: 3678486651 Enrollment ID: I20050714000692 |
| Provider Name | Grace Enu Clerk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093481772 PECOS PAC ID: 9931506243 Enrollment ID: I20210928003412 |
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