Individual
MR. JASON LEE GALLEGUILLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2917 C ST, UNIT 187, SAN DIEGO, CA 92102-2296
(760) 208-8939
Mailing address
2917 C ST, UNIT 187, SAN DIEGO, CA 92102-2296
(760) 208-8939
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/01/2012
Last updated
11/03/2012
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