Individual
SANQUELA DEONA GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(706) 990-9926
Mailing address
5264 BEACHFRONT COVE ST UNIT 217, SAN DIEGO, CA 92154-5251
(706) 990-9926
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/13/2022
Last updated
05/25/2023
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