Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bradford Lively, PA-C

Individual provider Physician Assistant · NPI 1134846835

Bradford Lively, PA-C is a Physician Assistant in Laguna Hills, California. Qualified in 2023, 3 years ago. Works from 2 locations.

Years since qualifying
3
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

24012 Calle De La Plata Ste 150
Laguna Hills, CA 92653-3632
Phone: (949) 588-7246
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 29300 Portola Pkwy Ste B, Lake Forest, CA 92630-8741 — (949) 919-6169

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1134846835
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 24, 2022
Last updated in NPPESAugust 4, 2026
Certification dateAugust 4, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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