| NPI | 1801140819 |
|---|---|
| Former Legal Business Name | LISA BRADSHAW A PROFESSIONAL CORPORATION |
| Entity Type | Organization |
| Authorized Contact | BOYD THOMAS BRADSHAW Business Manager 951-779-1966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CA 18295) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |