Individual
ALONZO JAMELLE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
REGIMENTAL AID STATION, 7TH MARINE HQ RAS, TWENTYNINE PALMS, CA 92278
(334) 370-7078
Mailing address
BOX 788-260, 2ND MARINE REGIMENT STATION, TWENTYNINE PALMS, CA 92278-8266
(334) 370-7078
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
7244689
AL
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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