Provider Demographics
NPI:1194479055
Name:HANADA, BRADLEY K
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:K
Last Name:HANADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 DANA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1109
Mailing Address - Country:US
Mailing Address - Phone:818-257-3898
Mailing Address - Fax:
Practice Address - Street 1:1340 DANA PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1109
Practice Address - Country:US
Practice Address - Phone:818-257-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)