Individual
DR. TRAVIS JAMES DE MIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8505 ARLINGTON BLVD STE 410, FAIRFAX, VA 22031-4636
(703) 560-9070
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 269-0674
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0101250347
VA
207V00000X
Obstetrics & Gynecology Physician
Primary
A108228
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/12/2007
Last updated
10/11/2019
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