Individual
JAY MICHAEL CHANNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
821 B AVE, CORONADO, CA 92118-2615
(619) 435-4794
Mailing address
821 B AVE, CORONADO, CA 92118-2615
(619) 435-4794
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
G16554
CA
Other
Enumeration date
03/03/2011
Last updated
03/03/2011
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