Individual
FREDDIE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34800 BOB WILSON DR, BLD 26, SAN DIEGO, CA 92134-1098
(619) 532-5792
Mailing address
1206 VIA ANGELICA, VISTA, CA 92081-6362
(619) 347-1721
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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