Individual
PATRICK MCTAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3781 ATLAS ST, SAN DIEGO, CA 92111-4353
(805) 479-8828
Mailing address
3781 ATLAS ST, SAN DIEGO, CA 92111-4353
(805) 479-8828
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
D8600867
CA
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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