Individual
JACOB JULIAN WIGDORSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-5109
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-5109
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/02/2024
Last updated
04/02/2024
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