Individual
MR. MICHAEL BLAKE COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
10255 LAFFEY CT, SAN DIEGO, CA 92124-2918
(757) 647-2668
Mailing address
10255 LAFFEY CT, SAN DIEGO, CA 92124-2918
(757) 647-2668
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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