Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 34568 | CA |
NPI | 1437741220 |
---|---|
Provider Name | Dr. Bradley Adam Fitzgerald |
First Address | San Diego, CA 92104-1105 |
Second Address | San Diego, CA 92104-1105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2021 |
Last Update Date | 03/02/2021 |