Individual
JOSHUA BRENT DEHAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2642 TRIDENT WAY BLDG 616, SAN DIEGO, CA 92155-5492
(331) 425-9749
Mailing address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(331) 425-9749
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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