Individual
BROCK CARL HARNISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2230 E 12TH ST, FREMONT, NE 68025-1610
(312) 375-4601
Mailing address
9089 CLAIREMONT MESA BLVD STE 200, SAN DIEGO, CA 92123-1225
(858) 810-8628
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
1476109
IN
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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