Individual
MR. LARRY ODELL NEELY
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) 532-6195
Mailing address
10125 BORDELON ST, SAN DIEGO, CA 92124-3204
(858) 444-0108
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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