Individual
JACKSON PRUETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
BLDG 4101, EL CAMINO REAL, FPO, AA, CA 92058
(760) 725-1288
Mailing address
PO BOX 555584, OCEANSIDE, CA 92055-5584
(760) 725-8912
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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