Bryan Jacob Willbanks, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3155 Salmon St
San Diego, CA 92124-3641

Phone

(843) 475-5341

NPI assigned

Jul 28, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1366884686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 SALMON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 SALMON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243641",
            "telephone_number": "843-475-5341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 Spruce Cape Rd",
            "address_purpose": "LOCATION",
            "city": "Kodiak",
            "state": "AK",
            "postal_code": "996156935",
            "country_code": "US",
            "telephone_number": "907-487-5193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLBANKS",
        "first_name": "BRYAN",
        "middle_name": "JACOB",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-28",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247000000X",
            "taxonomy_group": "",
            "desc": "Technician, Health Information",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Anne Willard, M.D.
• Kimberly Willard, MD
• Laura Elisabeth Willard, PSY.D.
• Melanie Leann Willard, DPT
• Natalie S. Willard
• Aaron Michael Willcott, MSPAS, PA-C
• Drita Willcox
• Florentina Willcoxson
• Crystal Willcuts, RBT
• Michelle Willcuts

• Independent Duty Corpsman in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.