Individual
BRADLEY A ELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 436-6365
Mailing address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 436-6365
(760) 436-5123
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS36308
CA
1223X2210X
Orofacial Pain Dentistry
Primary
DS36308
CA
125Q00000X
Oral Medicine Dentistry
DS36308
CA
174400000X
Specialist
36308
CA
208VP0000X
Pain Medicine Physician
Primary
DS36308
CA
332BC3200X
Customized Equipment (DME)
36308
CA
Other
Enumeration date
08/31/2006
Last updated
05/11/2026
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