Individual
BRYAN VILLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
2D MARINE RAIDER BATTALION, CAMP LEJEUNE, NC 28540
(910) 440-7704
Mailing address
206 PINE ISLAND DR, HAMPSTEAD, NC 28443-6500
(347) 850-5560
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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