Individual
BRANDON LANE THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
10004 LOS RANCHITOS RD, LAKESIDE, CA 92040-2724
(360) 689-2613
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/04/2021
Last updated
12/03/2021
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