Individual
NIA CLARKE CRISP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SFIDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(210) 487-9597
Mailing address
1475 ISLAND AVE UNIT 1410, SAN DIEGO, CA 92101-8237
(210) 487-9597
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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