Provider Demographics
NPI:1992927925
Name:MUNDWILER, BRADLEY DANN
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DANN
Last Name:MUNDWILER
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 1:27366 IDA LN
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8243
Mailing Address - Country:US
Mailing Address - Phone:951-623-4704
Mailing Address - Fax:
Practice Address - Street 1:464 S PALM AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4808
Practice Address - Country:US
Practice Address - Phone:951-658-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA715237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter