Provider Demographics
NPI:1720508476
Name:BRADSHAW, CAITLIN (DO)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:111 CAMPUS WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4212
Mailing Address - Country:US
Mailing Address - Phone:760-806-5700
Mailing Address - Fax:
Practice Address - Street 1:111 CAMPUS WAY STE 301
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4212
Practice Address - Country:US
Practice Address - Phone:760-806-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0064813207Q00000X
CA20A16970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine