Individual
JAKE GARRETT THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
303 COMBINE CT, RICHLANDS, NC 28574-6404
(920) 287-1256
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/04/2021
Last updated
12/03/2021
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