Individual
TITUS LUKE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2695 SHOUP DR, SAN DIEGO, CA 92110-4268
(931) 335-9190
Mailing address
2695 SHOUP DR, SAN DIEGO, CA 92110-4268
(931) 335-9190
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
098639276
TN
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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