Individual
BRYAN JACOB WILLBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3155 SALMON ST, SAN DIEGO, CA 92124-3641
(843) 475-5341
Mailing address
3155 SALMON ST, SAN DIEGO, CA 92124-3641
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
171000000X
Military Health Care Provider
—
—
1710I1002X
Independent Duty Corpsman
Primary
—
—
174H00000X
Health Educator
—
—
246RP1900X
Phlebotomy Technician
—
—
247000000X
Health Information Technician
—
—
Other
Enumeration date
07/28/2013
Last updated
05/14/2025
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