Individual
MR. KOMI VENUNYE GAYAKPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
(651) 354-8825
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6513548825
INDEPENDENT DUTY CORPSMAN
—
01
—
IDC
INDEPENDENT DUTY CORPSMAN
—
Enumeration date
07/27/2020
Last updated
12/22/2022
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