Provider Demographics
NPI:1427126572
Name:BRADLEY H CHESLER M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRADLEY H CHESLER M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CHESLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-673-9991
Mailing Address - Street 1:1955 CITRACADO PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4112
Mailing Address - Country:US
Mailing Address - Phone:760-738-5533
Mailing Address - Fax:760-738-3835
Practice Address - Street 1:1955 CITRACADO PKWY STE 203
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4112
Practice Address - Country:US
Practice Address - Phone:760-738-5533
Practice Address - Fax:760-738-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43963208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439631Medicaid
CA1505013OtherBLUE CROSS
CA00A439630Medicaid
CA125649400OtherU.S. DEPARTMENT OF LABOR
BC457AOtherMEDICARE PTAN
CA=========920250000OtherTRICARE
CA=========920250000OtherTRICARE
A43963Medicare ID - Type UnspecifiedMEDICARE