Individual
KENNETH SHEPPARD MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(757) 968-8770
Mailing address
3385 DRAYTON LN, SAN DIEGO, CA 92123-2048
(757) 256-8311
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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