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Physicians General Practice

Provider NPI: 1235390733

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 619-545-0410  Fax: --

Business Mailing Address:
34800 BOB WILSON DR  SAN DIEGO, CA 92134-1098 US
Tel: 619-545-0410  Fax: --

NPI Information:
NPI: 1235390733
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
General Practice
Military Hospital
Military Hospital
Military Hospital
Organized Health Care Education/Training Program

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 208D00000X





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