Individual
KEOKY DELAPENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC STUDENT
Contact information
Practice address
14101 FARENHOLT AVENUE BLDG 14, SAN DIEGO, CA 92134-5291
(619) 532-7968
Mailing address
14101 FARENHOLT AVENUE BLDG 14, SAN DIEGO, CA 92134-5291
(619) 532-7968
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/26/2021
Last updated
01/26/2021
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