Individual
COY DYLAN PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
INDEPENDENT DUTY COR
Contact information
Practice address
SURFACE WARFARE MEDICAL INSTITUTE, 34101 FARENHOLT AVE, SAN DIEGO, CA 92134
(619) 532-6659
Mailing address
11439 MADERA ROSA WAY, SAN DIEGO, CA 92124
(949) 295-8153
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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