Individual
BRENT WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 E. VANDERBILT WAY, SAN BERNARDINO, CA 92415-0026
(909) 387-7200
Mailing address
25571 LANE ST, LOMA LINDA, CA 92354-2412
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A142234
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2014
Last updated
08/20/2018
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