Individual
MR. DERICK MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-7714
Mailing address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-7714
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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