Provider Demographics
NPI:1275783755
Name:BRINKLEY, WILLA LILLY (DO)
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:LILLY
Last Name:BRINKLEY
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 1:140 AVE ALGODON
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4182
Mailing Address - Country:US
Mailing Address - Phone:949-366-0432
Mailing Address - Fax:888-508-3372
Practice Address - Street 1:140 AVENIDA ALGODON
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4182
Practice Address - Country:US
Practice Address - Phone:949-366-0432
Practice Address - Fax:888-508-3372
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0825421OtherNONE