Individual
DERRICK CANNON I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 E GILBERT ST, SAN BERNARDINO, CA 92415-1403
(909) 388-5644
Mailing address
201 W MILL ST, SAN BERNARDINO, CA 92408-1403
(909) 388-5644
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
11/26/2019
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