Rodriques Demario Santil Bradley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62466 Issued in CA

Practice address

1811 N Western Ave
Los Angeles, CA 90027-3403

Phone

(323) 533-5626

NPI assigned

Mar 13, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Rodriques Demario Santil Bradley Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: rodriques.bradley.1@29786.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1407557861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 N WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900273403",
            "telephone_number": "704-616-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 N WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900273403",
            "telephone_number": "323-533-5626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "RODRIQUES",
        "middle_name": "DEMARIO SANTIL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RODRIQUES",
            "last_name": "BRADLEY",
            "middle_name": "DEMARIO SANTIL",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Enrique Sherman Bradley, CRNA, M.S.
• Jacklyn Levena Bradley
• Latrice Bradley, LCSW
• Lisa Laverne Bradley, PA-C
• Mallory Kate Bradley, FNP
• Sandra L Bradley
• Sonia Ashling Bradley, AMFT
• Spencer Bradley
• Tasha Lashun Bradley
• Taylor Bradley, PMHNP

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.