Individual
HARRY STONE WILTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
26033 CAPE DR, LAGUNA NIGUEL, CA 92677-0914
(251) 504-7536
Mailing address
PO BOX 555341, CAMP PENDLETON, CA 92055-5341
(760) 725-6579
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1453970546
DODID
—
Enumeration date
06/08/2021
Last updated
06/08/2021
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