Individual
ALBERT EADDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4841 JESSIE AVE APT 8, LA MESA, CA 91942-8662
(619) 672-7439
Mailing address
4841 JESSIE AVE APT 8, LA MESA, CA 91942-8662
(619) 672-7439
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
2012031347
CA
Other
Enumeration date
03/29/2013
Last updated
03/29/2013
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