Individual
DE'RON HACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3132 JEFFERSON ST, SAN DIEGO, CA 92110-4421
(619) 683-3100
Mailing address
1400 13TH ST APT 216, IMPERIAL BEACH, CA 91932-3721
(619) 942-7070
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/09/2021
Last updated
06/28/2024
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