Individual
DANIEL GRANT REDIFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
1MRB 555341, CAMP PENDLETON, CA 92055
(760) 725-5298
Mailing address
PO BOX 555341, CAMP PENDLETON, CA 92055-5341
(760) 725-5298
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1397071622
USN
—
Enumeration date
09/23/2019
Last updated
09/23/2019
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