Individual
CORY DEVIN MACKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
490 N GRAPE ST, ESCONDIDO, CA 92025-3079
(760) 975-9939
Mailing address
490 N GRAPE ST, ESCONDIDO, CA 92025-3079
(760) 975-9939
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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