Individual
ANDREW ISAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DEEP SEA DIVE IDC
Contact information
Practice address
34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO, SAN DIEGO, CA 92134-0001
(619) 532-6400
Mailing address
6207 PASEO ENCANTADA, CAMARILLO, CA 93012-9421
(805) 827-0529
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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