Individual
DAMON MARCUS DERTINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34800 BOB WILSON DR STE 409, DEPT OF ANESTHESIOLOGY, NAVAL MEDICAL CENTER SAN DIEGO, SAN DIEGO, CA 92134-1409
(619) 453-6922
Mailing address
34800 BOB WILSON DR STE 409, DEPT OF ANESTHESIOLOGY, NAVAL MEDICAL CENTER SAN DIEGO, SAN DIEGO, CA 92134-1409
(619) 453-6922
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A98936
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A989360
BLUE SHIELD OF CA
CA
05
—
1588877963
—
CA
Enumeration date
05/08/2007
Last updated
06/07/2023
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