Active NPI
Willa Lilly Brinkley, DO
- General Practice Physician
- San Clemente, CA
National Provider Identifier
1275783755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 20A4676
- Practice address
- 140 Avenida Algodon
San Clemente, CA 92672-4182 - Phone
- (949) 366-0432
- Fax
- (888) 508-3372
- NPI assigned
- Sep 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 20A4676 | CA | Primary |
Addresses
Primary practice location
140 Avenida Algodon
San Clemente, CA 92672-4182
Mailing address
140 Ave Algodon
San Clemente, CA 92672-4182
Phone (949) 366-0432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33-0825421 | Other | CA | NONE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4676 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1275783755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 AVE ALGODON",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926724182",
"telephone_number": "949-366-0432",
"fax_number": "888-508-3372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 AVENIDA ALGODON",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926724182",
"telephone_number": "949-366-0432",
"fax_number": "888-508-3372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRINKLEY",
"first_name": "WILLA",
"middle_name": "LILLY",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-22",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "20A4676",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "33-0825421",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.