Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 20A14792 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | DO2364 | NV |
NPI | 1124368667 |
---|---|
Provider Name | Dr. Candice Lillian Brady |
First Address | Camarillo, CA 93012-5901 |
Second Address | Camarillo, CA 93012-5901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 11/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO2364 | NV LICENSE (01) | NV |