Individual
PIOTOR JUCHNIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
162 1ST ST, PORT HUENEME, CA 93043-4316
(312) 551-6370
Mailing address
3168 SALMON ST, SAN DIEGO, CA 92124-3616
(843) 437-5493
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B-300-0019
UNITED STATES NAVY
CA
Enumeration date
09/30/2014
Last updated
09/30/2014
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