Individual
MR. JORGE E TALAVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3875 FLORIDA ST APT 2, SAN DIEGO, CA 92104
(760) 585-8030
Mailing address
3875 FLORIDA ST APT 2, SAN DIEGO, CA 92104-6241
(760) 585-8030
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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