Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | A54360 | CA |
Y | 207RP1001X | Pulmonary Disease | A54360 | CA |
NPI | 1063434132 |
---|---|
Provider Name | Mr. Bradley Lawrence Spitz |
First Address | San Diego, CA 92103-2231 |
Second Address | San Diego, CA 92103-2231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A543600 | (05) | CA |
E45452 | (02) | CA |