Individual
LEVI PARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
2D RECONNAISSANCE BN, PSC 20138, CAMP LEJEUNE, NC 28452-0138
(910) 440-7703
Mailing address
2110 W MCMANAMON RD, OTHELLO, WA 99344-9027
(509) 308-0864
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/29/2020
Last updated
10/30/2020
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