Organization
MOBILE WOUND CARE-SAN DIEGO ND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NHI DAI PA-C (PHYSICIAN ASSISTANT- CERTIFIED)
(702) 927-3599
Entity
Organization
Contact information
Practice address
1415 SANTA DIANA RD, CHULA VISTA, CA 91913-2745
(702) 927-3599
Mailing address
1415 SANTA DIANA RD UNIT 9, CHULA VISTA, CA 91913-2745
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
54015
CA
Other
Enumeration date
02/06/2017
Last updated
02/07/2017
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