Individual
KENNETH EDWARD SIEBERT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
4831 SHIELDS ST, SAN DIEGO, CA 92124-2930
(619) 332-9330
Mailing address
4831 SHIELDS ST, SAN DIEGO, CA 92124-2930
(619) 332-9330
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/15/2020
Last updated
04/15/2020
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