Individual
TED CASILLAN GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10226 BORDELON ST, SAN DIEGO, CA 92124-3207
(858) 790-1088
Mailing address
10226 BORDELON ST, SAN DIEGO, CA 92124-3207
(858) 790-1088
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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