Active NPI
Elise Baldwin Bradley, PH.D.
- Clinical Neuropsychologist
- San Diego, CA
National Provider Identifier
1295120491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 32335
- Practice address
- 12526 High Bluff Drive Suite
Suite 300
San Diego, CA 92130 - Phone
- (858) 314-8335
- Fax
- (855) 706-2056
- NPI assigned
- Apr 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | P0000003132 | TN | |
| Clinical Psychologist | 103TC0700X | 32335 | CA | |
| Clinical Psychologist | 103TC0700X | P0000003132 | TN | |
| Clinical Neuropsychologist | 103G00000X | 32335 | CA | Primary |
Addresses
Primary practice location
12526 High Bluff Drive Suite
Suite 300
San Diego, CA 92130
Mailing address
4653 Carmel Mountain Rd
Suite 308 #232
San Diego, CA 92130
Phone (858) 314-8335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 7, 2023 through Jan 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32335 | CA | MD | Clinical Psychologist |
| P0000003132 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615507200000",
"number": "1295120491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4653 CARMEL MOUNTAIN RD",
"address_2": "SUITE 308 #232",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92130",
"telephone_number": "858-314-8335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12526 HIGH BLUFF DRIVE SUITE",
"address_2": "SUITE 300",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92130",
"telephone_number": "858-314-8335",
"fax_number": "855-706-2056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "ELISE",
"middle_name": "BALDWIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-03",
"last_updated": "2021-03-12",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "TN",
"license": "P0000003132",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "32335",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P0000003132",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "32335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.