Individual
KRISTOFFER RAY TIERRA COLLERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
6516 FRIARS RD APT 103, SAN DIEGO, CA 92108-1037
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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