1063298081 NPI number — ZONYA CRYSTAL LOLETIA BRADFORD MATTHEWS

Table of content: ZONYA CRYSTAL LOLETIA BRADFORD MATTHEWS (NPI 1063298081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063298081 NPI number — ZONYA CRYSTAL LOLETIA BRADFORD MATTHEWS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD MATTHEWS
Provider First Name:
ZONYA
Provider Middle Name:
CRYSTAL LOLETIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADFORD
Provider Other First Name:
ZONYA
Provider Other Middle Name:
CRYSTAL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063298081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3117 WILSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93304-5319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-324-4756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MCKEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93307-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-837-6060
Provider Business Practice Location Address Fax Number:
661-834-7566
Provider Enumeration Date:
09/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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