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1881277192
BRANDON LANE THIELE
SAN DIEGO, CA
NPI
1881277192
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2021-05-04
Last Update Date
2021-12-03
Business Address
BRANDON LANE THIELE IDC
34101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA 92134-7000
Phone number: 619-532-7968
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Mailing Address
BRANDON LANE THIELE IDC
10004 LOS RANCHITOS RD
LAKESIDE, CA 92040-2724
Phone number: 360-689-2613
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