Provider Demographics
NPI:1487760997
Name:WRUBEL, BRADLEY T (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:T
Last Name:WRUBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-8140
Mailing Address - Fax:510-506-7721
Practice Address - Street 1:2850 TELEGRAPH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1192
Practice Address - Country:US
Practice Address - Phone:510-204-8140
Practice Address - Fax:510-506-7721
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG709972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70997OtherSTATE MEDICAL LICENSE
CAF94841Medicare UPIN