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Individual

JAKE SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
3900 LOMALAND DR, SAN DIEGO, CA 92106-2899
(619) 244-1291
Mailing address
7385 PRINCETON AVE, LA MESA, CA 91942-8717

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000028483
CA

Other

Enumeration date
02/28/2019
Last updated
02/28/2019
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