Provider Demographics
NPI:1851865323
Name:KAUFER, BRADLEY Q
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:Q
Last Name:KAUFER
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 1:9933 MUSCATEL ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-9744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9933 MUSCATEL ST
Practice Address - Street 2:
Practice Address - City:OAK HILLS
Practice Address - State:CA
Practice Address - Zip Code:92344-9744
Practice Address - Country:US
Practice Address - Phone:760-949-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer