Individual
DOSH PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
SWMI FARENHOLT AVENUE, BUILDING 14, SAN DIEGO, CA 92134
(619) 532-7968
Mailing address
SWMI FARENHOLT AVENUE, BUILDING 14, SAN DIEGO, CA 92134
(619) 532-7968
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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