Individual
JUSTIN KEITH REDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(619) 532-7968
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26637465
—
TX
Enumeration date
09/02/2020
Last updated
11/27/2023
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