Individual
JUSTIN ALLEN RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
409 CAMINO DEL RIO S, SAN DIEGO, CA 92108-3504
(619) 381-7748
Mailing address
409 CAMINO DEL RIO S, SAN DIEGO, CA 92108-3504
(619) 381-7748
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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