Most Relevant Information
Provider Data
| NPI Number: | 1003325499 |
| Provider Name: | BRADLY JAMES STILLEY IDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/28/2017 |
| Last Updated: | 09/28/2017 |
Provider Practice Location
34800 BOB WILSON DR
SAN DIEGO
CA
921341098
Practice Location Phone/Fax
| Phone: | 3609419989 |
| Fax: |
Provider Mailing Location
10156 ORLECK ST
SAN DIEGO
CA
921242509
Provider Mailing Phone/Fax
| Phone: | 3609419989 |
| Fax: |