Individual
PAUL ANDREW VIRTUE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
1ST RECON BN BAS, CAMP PENDLETON, CA 92055
(760) 725-8912
Mailing address
PO BOX 555584, CAMP PENDLETON, CA 92055-5584
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
02239573PV
NC
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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