Individual
MICHAEL MATTHEW FREGOLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34520 BOB WILSON DR, SAN DIEGO, CA 92134-2098
(619) 532-0700
Mailing address
1781 BACON ST, SAN DIEGO, CA 92107-3237
(321) 426-5688
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/07/2019
Last updated
01/07/2019
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