Individual
DENNIS BUENAVENTURA CUSTODIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
INDEPENDENT DUTY HM
Contact information
Practice address
69 TROUT AVE, NAVAL UNDERSEA MEDICAL INSTITUTE, GROTON, CT 06349
(253) 905-8239
Mailing address
6910 227TH STREET CT E, SPANAWAY, WA 98387-5841
(253) 905-8239
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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