Provider Demographics
NPI:1063434132
Name:SPITZ, BRADLEY LAWRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:SPITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHINGTON ST STE 725
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2241
Mailing Address - Country:US
Mailing Address - Phone:619-299-2570
Mailing Address - Fax:619-299-2216
Practice Address - Street 1:501 WASHINGTON ST STE 725
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2241
Practice Address - Country:US
Practice Address - Phone:619-299-2570
Practice Address - Fax:619-299-2216
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54360207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543600Medicaid
CAA54360Medicare ID - Type Unspecified
CA00A543600Medicaid