Individual
NOLAN ANDREW ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DIVE IDC
Contact information
Practice address
3156 SALMON ST, SAN DIEGO, CA 92124-3616
(859) 802-9800
Mailing address
3156 SALMON ST, SAN DIEGO, CA 92124-3616
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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