Provider Demographics
NPI:1124368667
Name:BRADY, CANDICE LILLIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:LILLIAN
Last Name:BRADY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMARILLO RANCH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5901
Mailing Address - Country:US
Mailing Address - Phone:805-273-5478
Mailing Address - Fax:805-852-2688
Practice Address - Street 1:400 CAMARILLO RANCH RD STE 101
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5901
Practice Address - Country:US
Practice Address - Phone:805-273-5478
Practice Address - Fax:805-852-2688
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2364207XX0004X
CA20A14792207XX0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2364OtherNV LICENSE