Individual
COREY JEVON BUCHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
NAVAL MEDICAL CENTER BALBOA 34800 BOB WILSON DRIVE, SAN DIEGO, CA 92134-0001
(619) 640-0155
Mailing address
3535 MONROE AVE UNIT 30, SAN DIEGO, CA 92116-3590
(361) 720-5257
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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