Organization
UNTIED STATES NAVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRED ALLEN LEE IDC (IDC)
(951) 992-9627
Entity
Organization
Contact information
Practice address
BLDG 620305 8TH STREET, CAMP PENDELTON, CA 92055
(951) 992-9627
Mailing address
BLDG 620305 8TH STREET, CAMP PENDELTON, CA 92055
(951) 992-9627
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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