Healthcare Provider Details

I. General information

NPI: 1366399057
Provider Name (Legal Business Name): BRADLEY MCCAMMACK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 JEFFERSON ST
CARLSBAD CA
92008-1743
US

IV. Provider business mailing address

1718 MEDINAH RD
SAN MARCOS CA
92069-1181
US

V. Phone/Fax

Practice location:
  • Phone: 310-465-5849
  • Fax:
Mailing address:
  • Phone: 310-465-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY MCCAMMACK
Title or Position: MD
Credential:
Phone: 310-465-5849