Provider Demographics
NPI:1902868714
Name:FELIZ, BRADY J (MD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:J
Last Name:FELIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:707-257-4076
Mailing Address - Fax:707-257-4133
Practice Address - Street 1:1000 TRANCAS ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2906
Practice Address - Country:US
Practice Address - Phone:707-257-4076
Practice Address - Fax:707-257-4133
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78704207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787046Medicaid
CA00A787046Medicaid
CA00A78740Medicare ID - Type UnspecifiedPPIN