Individual
DAELEN ROBERT JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6400
Mailing address
761 GEORGIA ST, IMPERIAL BEACH, CA 91932-2344
(904) 657-7075
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/10/2025
Last updated
04/10/2025
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