Organization
U.S. NAVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENEDICTO VICENCIO MANALANSAN (INDEPENDENT DUTY CORPSMAN)
(619) 475-1100
Entity
Organization
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 245-1693
Mailing address
2240 SPRING OAK WAY, SAN DIEGO, CA 92139-3922
(619) 475-1100
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDENT DUTY CORPSMAN
CA
Enumeration date
04/02/2006
Last updated
05/19/2008
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