Individual
GAVINO MARTIN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
1ST MARINE RAIDER BATTALION MEDICAL, 555341, CAMP PENDLETON, CA 92055-5341
(760) 725-2589
Mailing address
PO BOX 555341, CAMP PENDLETON, CA 92055-5341
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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