Individual
MITCHELL HEIMLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10142 KEPPLER DR, SAN DIEGO, CA 92124-2504
(719) 322-3128
Mailing address
10142 KEPPLER DR, SAN DIEGO, CA 92124-2504
(719) 322-3128
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/26/2021
Last updated
06/30/2022
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