Provider Demographics
NPI:1316619398
Name:BRADLEY, GABRIEL EZRA (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:EZRA
Last Name:BRADLEY
Suffix:
Gender:
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:GABRIELLE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 RAND AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2210
Mailing Address - Country:US
Mailing Address - Phone:818-333-6424
Mailing Address - Fax:
Practice Address - Street 1:4555 PRECISSI LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5743
Practice Address - Country:US
Practice Address - Phone:818-333-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031422363LW0102X
CA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health