Individual
MR. MITCHEL GRANDE DEGUZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE, BUILDING 14, SAN DIEGO, CA 92134-5291
(619) 252-8557
Mailing address
PO BOX 555381, CAMP PENDLETON, CA 92055-5381
(760) 725-8805
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/29/2012
Last updated
02/29/2012
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