Basic Information
| Provider Information | |||||||||
| NPI: | 1194740217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | LETITIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7485 RUSH RIVER DR | ||||||||
| Address2: | SUITE 710-323 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958315259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939303431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855471 | ||||||||
| FaxNumber: | 8313855940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A70194 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | LT-2827 | NH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 14581 | NH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30208936 | 05 | NH | MEDICAID | 00A701940 | 05 | CA | MEDICAID |