Individual
THAYSHA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(860) 983-2042
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(860) 983-2042
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
05/21/2015
Last updated
05/21/2015
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