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NPI Code Detail

MEDICARE: MR. BRADLEY DAMON AMFT

MEDICARE: MR. BRADLEY DAMON AMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist160943CA

General Provider Information

NPI Number : 1538015904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADLEY DAMON AMFT
Provider Business Mailing Address
First Line : 23 E SAN MIGUEL DR
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-1509
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2851 CAMINO DEL RIO S STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3814
Country : US
Telephone Number : 619-632-5434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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