Individual
MR. CHRISTOPHER ROBERT TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2446 TRIDENT WAY, CORANADO, CA 92155
(619) 537-2361
Mailing address
2446 TRIDENT WAY, CORANADO, CA 92155
(619) 537-2361
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08983
CERTIFICATE OF GRADUATION, NAVAL SCHOOL OF HEALTH SCIENCES
CA
Enumeration date
08/06/2009
Last updated
05/24/2013
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