Individual
DURELL JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-5291
(619) 532-7968
Mailing address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-5291
(619) 532-7968
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1710L1002X-
CA
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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