Individual
JOSEPH ROMAN SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3166 BARNETT AVE, SAN DIEGO, CA 92110-4204
(619) 876-6546
Mailing address
3166 BARNETT AVE, SAN DIEGO, CA 92110-4204
(619) 876-6546
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
SP409958
OH
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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